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Membership Application - Please print this page and fill it in -
| First Name: | |
| Last Name: | |
| Address: | |
| City: | |
| Postal Code: | |
| Date of Birth: | |
| Phone | |
| What are your interests? | |
| Are you interested in being a volunteer? | |
| For what activities? |
| Membership Fee: $ 10.00 per year |
| Calendar Year: January 1st - December 31st |
______________________________________________
- Signature -
Please print and mail or
e-mail to:
Elder
Active Association
4061 -
4th Avenue
Whitehorse, Y1A 1H1