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Membership Application Form


  

One of the keys to the strength of our organization is the NMRC Membership. Annual membership fees help us continue to provide services and programs which support men, families, women and children.  

When you become a member you will receive a membership card and you will be sent regular notifications about NMRC workshops, new programs and our monthly NMRC E-Newsbyte. 

Please fill in the following information to register your membership and email it to info@nanaimomen.com .  If you are paying by cheque, you can either bring it by our office or mail your application along with cheque to 418D Fitzwilliam Street, Nanaimo BC, Canada V9R 3A7.  If you would like to pay by visa, forward application by email or fax, and then please phone our office at 250-716-1551 or toll free 1-877–716-1551 to process your visa payment over the phone.  [membership will become valid when payment is received]  If you have any questions, please phone us at the numbers listed above.  

Thank you for your support. 

 

Today's date: -- mm/dd/yy

Please provide the following contact information:

*First Name
*Last Name
*Title
Organization
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
*Country
Work Phone
*Home Phone
FAX
*E-mail
URL

Do you belong to another organization working with similar issues?

Yes No

Name of Organization?


Is this a new membership?

Yes No

By clicking the box below I agree to the principles stated in the Constitution of the Nanaimo Men's Resource Centre, a Registered Society under the provisions of the Society Act of British Columbia. I further agree to comply with the Constitution & Bylaws of this Society as may be amended from time to time pursuant to the by-laws.

I agree

Personal Annual Membership Fee:

$10.00

Corporate Annual Membership Fee:

$100.00

 
Revised: July 07, 2009