IMPORTANT ADVISORY TO OUR MEMBERSHIP

The LDANB Board of Directors have passed a motion that memberships dues be payable on the same date each year during the month of October.

This will come into effect as of October 2007.

LDANB MEMBERSHIP FORM

$25.00 / year - October to September
This information is private and confidential.
Please print clearly.

TITLE:     MISS     MS    MRS   MR     DR

2. MAILING ADDRESS:

CITY/PROV.: __________________  POSTAL CODE: ____________

3. PHONE:

4. LANGUAGE:   ENGLISH  FRENCH    OTHER ____________________

5. TYPE OF MEMBERSHIP:
INDIVIDUAL   STUDENT    FAMILY

If family please circle (optional)

6. NEW MEMBER  RENEWAL

7. PAYMENT:           CASH    MONEY ORDER    CHEQUE

Please make payable to: Learning Disabilities Association of New Brunswick

VISA CARD #: ____________________    EXPIRY DATE:____________________

SIGNATURE: ___________________________________

(Must be signed to be valid)

Member of the Learning Disabilities Association of Canada