THE COURTENAY &
DISTRICT
MUSEUM & HISTORICAL
SOCIETY


INSTRUCTIONS:

   Complete all applicable entries, especially your identification information and check or money order number.
   Send the information to the Courtenay & District Museum by clicking on the Send this entire form button at the bottom of this page. This will confirm your order with us.
   Make your check or money order out to the Courtenay & District Museum, in Canadian funds.
   Print out this entire page using the print command on your browser's toolbar.
   Mail or hand deliver the printed document and appropriate payment to:
          The Courtenay & District Museum
          360 Cliffe Avenue,
          Courtenay, B.C.
          Canada
          V9N 2H9
   Your card and information package will be mailed to you as soon as your check or money order is received. Thereafter, you will be eligible for all the advantages that membership implies.
   If you have any difficulties, please contact us either by email, or by phone: (250) 334-3611.


  Yearly Membership Application
        (Prices include all applicable taxes)
Yes! Please sign me up as a partner of the Courtenay & District Historical Society:
Single Membership.........................CDN $10.70
Family Membership........................CDN $16.05
Corporate Membership..................CDN $26.75
Lifetime Membership......................CDN $107.00

  Endowments
         (Prices include all applicable taxes)
Even Better! Tax deductible contributions will be greatfully received in trust to the Comox Valley Community Foundation, in support of the Museum's many conservation efforts:
Supporter.......................................CDN $50.00
Friend............................................CDN $75.00
Patron............................................CDN $100.00
Please accept my contribution of:...

Please check here if you would like your contribution
      to go directly to the Museum's Building Fund.

  Keeping In Touch
Thank you! If you have either joined the Society or made a contribution to our Endowment Fund, please complete the following so that we can keep in touch:

MONTH:                   YEAR:     

NAME:


MAILING ADDRESS:


EMAIL ADDRESS:


CITY:                                    PROVINCE/STATE:
     

POSTAL/ZIP CODE:            PHONE:
     () 

CHECK/
 MONEY ORDER NUMBER: