Friends of Ecological Reserves
Box 8477 Stn Central Victoria BC V8W 3S1

Membership & Donations Form

1. print this form and complete it manually, OR
2. complete the form on-line, then print it AND
3. send with your cheque to the above address.

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Membership
Page

Name (Please Print)
Street Address
City
Province/State
Postal Code
Phone (optional)
eMail (optional) check this box if	instead of receiving the LOG by post as a paper version, send me my copy of the LOG electronically in PDF. format

Membership Type	New Member	Renewal
Category	Individual: $20.00	Student: $15.00
	Senior: $15.00	Family $25.00
	Institution: $25.00

Payment for Membership	$
Donation (tax receipt BIN#118914597RR will be issued for any donation of $20.00 or more)	$
Copies of Constitution @ $1.00 ea.	$
Total Cheque/Money Order Enclosed	$

Apply my donation to:	I am interested in volunteering for:
Land Acquisition	Assisting with Field Trips
Research Grants	Assisting with The Log
Where Most Needed	Assisting with Fund Raising
	Assisting with telephone work
	Other