2006 Membership Form


Membership Fee  $10          Additional Contribution   $ ________________           Date:________________

Name: __________________________________________________________________________________

Resident and/or Taxpayer in Alleyn-and-Cawood?                 Yes ______________   No ________________

Home tel. No.   (       ) ______________________      Bus/Cell Tel. No. (       ) _________________________

E-mail address ____________________________________________________________________________

Home mailing address ______________________________________________________________________

_________________________________________________________________________________________
Mail your membership form, annual fee and donation to:
Coalition Against Danford Megadump
P.O. Box 911, Danford Lake, QC J0X 1P0