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Get Download Our 2017 Membership Form - Community Living Victoria

Thank you for your support. CLV may contact you in the future to send you fundraising information to assist people with developmental disabilities and their families. Please call or e-mail kgreen clvic.ca if you do not wish to be contacted. 3861 Cedar Hill Cross Road Victoria BC V8P 2M7 T 250-477-7231 F 250-477-6944 www. Dues cover the calendar year January 1 December 31 2017 You will receive a tax deductible receipt. Thank you for your support. CLV may contact you in the future to send you fundraising information to assist people with developmental disabilities and their families. Membership in Community Living Victoria for the year 2017 as o an individual - 20 a family 2 or more - 35 an organization/company - 35 please check one Cheque enclosed in the amount of Visa Card Expiry Date MasterCard Expiry Date Signature Date If you are paying by credit card please note that you will receive another membership notice next year as we do not keep the card numbers on file. Dues cover the calendar year January 1 December 31 2017 You will receive a tax deductible receipt. Name s Address Email Postal Code Phone Home Phone Work o I would prefer to receive correspondence by email only. Membership in Community Living Victoria for the year 2017 as o an individual - 20 a family 2 or more - 35 an organization/company - 35 please check one Cheque enclosed in the amount of Visa Card Expiry Date MasterCard Expiry Date Signature Date If you are paying by credit card please note that you will receive another membership notice next year as we do not keep the card numbers on file. MEMBERSHIP FORM Please fill out the following information and return it with your payment to the address below. Name s Address Email Postal Code Phone Home Phone Work o I would prefer to receive correspondence by email only. MEMBERSHIP FORM Please fill out the following information and return it with your payment to the address below.

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