Membership Application

Port Moody Heritage Society

Membership Fees: Basic $10 Corporate $25 Life $500

Name: __________________________________________________

Address: __________________________________________________

City: __________________________________________________ Postal Code: ___ ___

Phone: ___ ___ ____ e-mail: _________________________

Date: _______________ Amount Enclosed: $__________

Signature: _________________________

Would you like to recieve email updates on Museum events?

[ ] Yes [ ] No

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 • web http://vcn.bc.ca/pmmuseum/

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

revised October 2, 2009