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 METHOD

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