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)