Mail to Membership Secretary, Richard III Society of Canada, by wuj11310

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									I enclose: ( ) $65.00 Cdn Regular Annual Membership
(Check one) ( ) $55.00 Cdn Senior / Student Annual Membership
            by cheque payable to The Richard III Society of Canada. Year begins October 2nd.

NAME: _____________________________________________________________________

ADDRESS: __________________________________________________________________

CITY: ________________________ PROV.: _________ POSTAL CODE: _______________

PHONE: _______________________ EMAIL: _____________________________________

DATE OF BIRTH (MONTH/DAY/YEAR): __________________

EDUCATIONAL INSTITUTION: (Students Only): _____________________________________
Information collected is for Society administrative purposes only. We do not release members’ personal details to other members or to any
 party outside the Society without your express written permission.

Mail to: Membership Secretary, Richard III Society of Canada, c/o 5238 Woodhaven Dr., Burlington, ON L7L 3T4                                (Website)

								
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