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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
____________________________________
Date