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DisAbled Women's Network (DAWN) Ontario


DAWN Ontario Membership Form


Please complete, and mail (or email) 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 at dawn@thot.net



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: ________________________________________________ Please send my information in: [ ] Print [ ] Large Print [ ] Audio Cassette Tape [ ] 3.5" Diskette - Specify Format & Version _____________________________________________ (e.g. WordPerfect 5.1; ASCII (DOS) text)


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