Transport 2000 Canada Membership Form
.

A. Check membership category.
(Price includes regional membership, which will vary according to the region)
 B.In addition to membership, if you can donate to Transport 2000 write in the amount of your donation.
(Charitable registration #: 0528349-59-10)		 C.Total (A + B)



Atlantic (Newfoundland, New Brunswick, Nova Scotia, Prince Edward Island)

( ___) $10 Special first year introductory rate
( ___) $25 Individual
( ___) $35 Family
( ___) $75 Non-profit Affiliate
( ___) $150 Business
( ___) $18 Senior
( ___) $18 Student
( ___) $75 Municipality

Quebec

Contact Transport 2000 Quebec directly for membership details. See their website: http://www.transport2000qc.org.

Ontario

( ___) $35 Individual
( ___) $55 Family
( ___) $100 Non-profit Affiliate
( ___) $185 Business
( ___) $28 Senior
( ___) $25 Student
( ___) $50 Municipality

West (Alberta, British Columbia, Manitoba, Northwest Territories, Nunavut, Saskatchewan, Yukon):

( ___) $30 Individual
( ___) $45 Family
( ___) $70 Non-profit Affiliate
( ___) $160 Business
( ___) $25 Senior
( ___) $20 Student
( ___) $50 Municipality

Outside Canada, or for memberships not affiliated with a specific region:

( ___) $30 Individual
( ___) $45 Family
( ___) $70 Non-profit Affiliate
( ___) $160 Business
( ___) $25 Senior
( ___) $20 Student
( ___) $50 Municipality

Donation:

$__________

 Total:

$__________

Signature: ____________________________________

Date: __________________________

Name:_______________________________________

Street: ______________________________________

City: _______________________________________

Prov: _________ Code: ___________

Telephone: _____________________

Work Phone: ____________________

E-Mail: ____________________

 Please send your cheque to:

Transport 2000 Canada
Box 858, Stn. B,
Ottawa, Ontario Canada
K1P 5P9



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