Last Name
First Name
Phone Number
Street Address
City
Province
Postal Code
Email
Website
Membership Type (please Check One)
Volunteer ($0/15 Hours of Volunteer work)
Student Senior or Unwaged ($10)
Individual($20)
Household(two individuals in same household $35)
Sustaining($100)
Payment Type
Cash
Cheque
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Volunteer 15 hours
Date Issued
Please tell us a bit about yourself, your art, etc.
