MEMBERSHIP APPLICATION
Please print this page, complete the information and mail it to the address below. Thank you for your support.

Annual membership is $25.00 for an individual and $50.00 for a family membership. Supporting memberships for Corporate and Business members are accepted. 

INDIVIDUAL MEMBER: $25.00 _____	FAMILY MEMBER: $50.00 _____
	SPECIAL GROUP MEMBERSHIP RATES ARE AVAILABLE

Name: _______________________________________________

Address: ____________________________________________

City: _______________________________________________

Province: ___________________________________________

Postal Code: ________________________________________

Home Phone: _________________________________________

Work Phone: _________________________________________

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Please indicate method of payment

CHEQUE____ VISA____ MASTERCARD____ OTHER____

(*** DO NOT SEND CASH THROUGH THE MAIL ***)

Card Number: ________________________________________

Expiry Date: ________________________________________

Signature: __________________________________________

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					for office use only

Date received: ______________________________________

Date issued: ________________________________________

Membership Number: __________________________________

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MAILING ADDRESS:	CANADIAN LIFEBOAT INSTITUTION,

			401 EAST WATERFRONT ROAD,

			VANCOUVER, B.C.

			V6A 4G9
The C.L.I. is a registered charity - number BN 88999-8977-RR0001

A tax receipt will be provided for all donations of $25.00 or more.