Gift Membership

Port Moody Heritage Society

Your Name: __________________________________________________ Date: __________

Amount Enclosed: $10 Basic $__________

Recipient's Name: __________________________________________________

Recipient's Address: __________________________________________________

City: __________________________________________________ Postal Code: ___ ___

Phone: ___ ___ ____ e-mail: _________________________

Donations to the museum are always gratefully accepted.

Tax receipts are provided for donations over $25 or by request.

Port Moody Station Museum, 2734 Murray Street, Port Moody, BC, V3H 1X2

Telephone: (604) 939-1648 • e-mail pmmuseum@telus.net • http://vcn.bc.ca/pmmuseum/

Print out form and take to museum with cash or cheque.

revised October 2, 2009