Membership Form

Name: Address:

City: Province/State: Postal: Code/Zip:

Phone: Fax: E-Mail:

Business ($100) Organization ($100) Individual ($20) Student/Senior ($10)

Persons or Organizations are also encouraged to make donations to the CCDS. Donations over $10 will receive a tax receipt. I would like to donate an additional $ to CCDS.

We now accept VISA

VISA Card No. Expiry date: / /

Signature:

Make fees and donations payable to:

Canadian Centre on Disability Studies Inc.

Mail to:

Canadian Centre on Disability Studies

56 The Promenade, Winnipeg MB R3B 3H9

Fax: 1-204-284-5343

Charitable # 899185367 RR 0001