Cowichan Community Land Trust Society

If you would like to become a member of the Cowichan Community Land Trust Society, and/or would like to make a donation, please print and complete this form and send it along with your cheque or money order to the address below. Charitable Tax receipts are issued for all donations. We greatly appreciate your support!

Our Charitable Registration Number is 1042654-52

Name: _________________________________________________
Address: ________________________________________________
City: _________________________________________________
Province/State: ___________________________________________
Postal Code/ZIP: __________________________________________
Country: _________________________________________________
Telephone: _____________________________________________
E-mail: _________________________________________________
Your Interests: __________________________________________
_________________________________________________
_________________________________________________

I would like to support the work of the Cowichan Community Land Trust Society:

Memberships:

____ $5.00/year for people under 19
____ $20.00/year for adults and families
____ $20.00-$100.00/year for other non-profit organizations
____ $100.00/year for business (members will be recognized in our newsletters and at our AGM)
____ $1000.00/year to be a Sponsor (Sponsor’s names and/or logos will appear on our literature and be posted at our office)

Donations:

____$25 ____$50 ____$100 ____$500 ______Other

____Cheque ____Money Order

Signature: ____________________________________________

Please make cheque or money order payable to "Cowichan Community Land Trust Society"

MAILING ADDRESS:

Cowichan Community Land Trust Society
#6 - 55 Station Street
Duncan, British Columbia, Canada
V9L 1M2

THANK YOU