Registration Form - Charleswood Historical Society

Application for Annual Membership

Choose One

New Member Returning Member

Date

Name(s)

Maiden Name (if applicable)

Address

City

Province

Postal Code

Email Address

Phone Number

Yes, I wish to receive emails from the Society

Yes

Number of years residing in Charleswood

Annual Membership Fee options:

Single $15.00 Family $20.00

Payment instructions to e-transfer your membership fee:

Send to chs74-secretary@outlook.ca

Please it is important to include your name and email address in the information box on your etransfer payment