Join Us – Simcoe North Conservative Association

Membership Application

Salutation

Mr. Mrs. Ms.

First Name

Last Name

Address Line 1

Address Line 2

City/Town

Province

Postal Code

Home Telephone

Cell Phone

Email Address

Date of Birth

Required by Elections Canada

Will you support us by accepting a lawn sign in the 2019 election?

Yes

Please note: Membership fees are non-refundable in accordance with Canada Revenue Agency Guidelines.

By submitting payment I certify that I meet the following Conditions of Membership:

I am a Canadian Citizen or Permanent Resident of Canada.

I actively support the founding principles of the Conservative Party of Canada

I am at least 14 years of age

I do not hold membership in another Federal Political Party.

My membership fees are paid from my own funds and no individual or organization will reimburse me.

Payment Section

Membership Term

1 Year - $15 2 Years - $25 3 Years - $35 4 Years - $45 5 Years - $50

Type of Credit Card

Visa Mastercard

Card Name

Name as it appears on the credit card

Credit Card Number

Card Expiration

CVC

3 digit security code from card back