In principle and practice, DAWN Ontario values and seeks a diverse membership. There shall be no barriers to full participation in this organization on the basis of gender, race, creed, age, sexual orientation, national origin, disability, or class.

If you are in a position to afford voluntary membership dues, you may mail your cheque or money order to:

Please print, complete, and mail membership form, along with your cheque or money order to:

DAWN Ontario
Box 1138
North Bay, ON   P1B 8K4
CANADA

Please email us for further information

---

ANNUAL FEE:
   
[   ] $10 - Individual 
[   ] $25 - Consumer-Run Group or Networking
[   ] $50 - Government 
[   ] $50 - Service Agency


Name: _______________________________________________

Organization: _______________________________________

Address: ____________________________________________

______________________________________ Apt # ________

City: _______________________________________________   

Province: _________________ Postal Code _____________

Daytime Phone Number: (_____) _______________________

Evening Phone Number: (_____) _______________________

Email:  _____________________________________________   

URL: ________________________________________________