Membership Form

I want to be a Canadian Peace Initiative member, and support initiatives for developing a culture of peace and a department of peace in Canada

• Name:
• Address:
• City: Province:
• Postal Code Phone Number:
• Email:

Is this a new membership?

Which local chapter will you join?_______ See Canadian Chapters for locations. We will send you the contact information for the chapter nearest to you.

Date:

I am particularly interested in learning about the following issues such as women & peace, foreign policy, peace education, creating a Chapter, nuclear disarmament, etc.

Please PRINT the completed form & mail your donation to the Canadian Peace Initiative at the address below.

Individual memberships are $10

Total Paid $ ______

Payment

• Cash and form given directly to a Chapter_____
• Cheque made payable to the Canadian Peace Initiative_____
• Paypal on our web site: www.departmentofpeace.ca_____

Memberships are not considered charitable contributions.     Thank you for your generous support.

Mail to

CPI, c/o Saul Arbess
45 Cambridge St.
Victoria, BC  V8V 4A7