APPLICATION FOR ACTIVE MEMBERSHIP

Please fill out the form, then print this page and mail it with your payment to WFA

Name in full:
Company name (if applicable):
Mailing Address:
City:
Province:		Postal Code:
Phone Number:
Fax Number:
E-Mail:
Date:	Did you remember to mail your dues?

Remain a voting member – remember to pay your dues annually.

All cheques to be made out to the Western Fallers Association

DO NOT WRITE IN THIS SPACE - FOR OFFICE USE ONLY

Annual dues of $107.00 received in full

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W.F.A. Authorized Signature
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Date