Please Join Us!

Membership is $10 per year. If you are already a member, you can also use this form for renewals and donations. However, please note that political contributions of more than $100.00 must be mailed to us as we need an original signature to comply with the Election Act. Thank-you!

New Membership / Membership Renewal
First Name
 Last Name
 Mr/Ms/Mrs/Miss/Dr
Suite No.
 Address
 Address (cont).
City
 Postal Code
 Email
Daytime Phone
 Evening Phone
 Fax Number
Mobile Phone
 Your Riding

(You can check this here)		 Election Volunteer

Term
 2 Years ($20)*
 1 Year ($10)*
Please add a donation
if you can. Thank-you!		  Donation*
 Visa  Mastercard  Cheque
Card Holder
Card Number  Expiry Date 


____________________________________
Signed

__________________________
Dated

Important Notice: By law we cannot accept political contributions of more than $100.00 without your signature. Section 186(1) c of the Election Act stipulates that all political contributions in excess of $100.00 made via a credit card must be accompanied by evidence of authorization of the contributor signed by the contributor. Therefore, if your political contribution is in excess of $100.00, you must print this form, sign at the bottom, and send it to us by regular mail. Political contributions of more than $100.00 submitted without a legal signature have to be returned. For political contributions of up to $100.00, we can take credit card information over the internet; to do so, simply complete this form and click on the "SUBMIT" button below. If you prefer, you can print this form, sign at the bottom, and fax it to 604-980-8833 or send it by regular mail to Reform BC, Box 16157, 1199, Lynn Valley Rd., North Vancouver, BC, V7J 2P0. Thank-you.

Thank-you for your support!
 
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