Manitoulin Island Dark Sky Association
Membership Form
Name: ______________________________________________________________
Address: ____________________________________________________________
City: _______________________________________________________________
Postal Code: _________________________________________________________
Phone: _____________________________ Fax: ____________________________
Email: _______________________________________________________________
Type of Membership: (please check one)
| Individual | ($15 Yearly) | O | Stellar |
| Family | ($30 Yearly) | O | Constellation |
| Business | ($45 Yearly) | O | Galaxy |
| Corporate | ($210+ Yearly) | O | Cosmic |
Total Enclosed :__________
Method of Payment: (please check one)
Chq:_____ Cash:_____
Please make cheques payable to:
Please Make Your Cheque Payable To:
The Manitoulin Island Dark Sky Association
C/O Mark Oldfield
1687 Carol St.
Val Caron, ON P3N 1H1
