Please print the form below, complete and mail it to the address at the bottom of the page

ANNUAL RENEWALS DUE DECEMBER 31st

Canadian Alliance of British Pensioners CAMPAIGN SUPPORTERS' MEMBERSHIP (single or couple)   New member or   Renewal of membership #: ........................... (If renewing, simply complete Membership # and name. Note any corrections below)
Title	First Name		Last Name
Apt/Unit.	Street address (or current members simply note membership # above)
City		Pr/State/County	Post/Zip Code	Country
Tel:		Fax:	E-mail:
please check      appropriate boxes	Single    Couple    Current Pensioner    Future pensioner    Willing to help
Annual Campaign Supporting Membership
Canadian Resident $20				.
Overseas Resident US$30 or £18 or Cnd$ 35
Action Fund donation (optional)   $50   $25   $10   $5 or
(Cheque or money order please - no cash)                 Total Payment Enclosed =>

Please mail this Web Site Form, including your Campaign Supporting Dues or payment to:

Canadian Alliance of British Pensioners,    202-605 Royal York Road, Toronto, ON M8Y 4G5 Canada

BC RESIDENTS ONLY -Please mail to: Canadian Alliance of British Pensioners,    PO BOX 2224, Vancouver, BC V6B 3W2