GARFAT FAMILY ASSOCIATION MEMBERSHIP APPLICATION FORM

Send to: (Membership Chairperson's name here)
Address....etc)

(PLEASE PRINT)

Applicant:

NAME:________________________________________________

ADDRESS:____________________________________________

____________________________________________

CITY: ____________________________________________

PROVINCE/STATE:_____________________________________

POSTAL CODE/ZIP:___________________________________________________
(If billing address is different, please enter billing address on the back of this form)

PHONE: RES:(____)-____-____ BUS: (____)-____-____)

FAX: (____)-____-____) E-MAIL___________________________

APPLICATION FOR MEMBERSHIP
Annual Membership Dues For Fiscal Year
(Janaury through December)
Billing Date: January 1st, each year.

Family Membership ...........................$25.00 Per Year
Individual Membership......................$20.00 Per Year

Members signing up during the last six months of a fiscal year will pay a prorated cost of $3.25 per month.