Membership Registration Form

First Name(required)

Last Name(required)

Email(required)

Phone

Address(required)

City(required)

Postal code(required)

New member?(required)

Yes No

Any changes from last year information?(required)

Yes No

May we publish your picture?(required)

Yes No

May we publish your contact info in the membership roster?(required)

Yes No

We are collecting information about Member Age to support future grant applications and to build a Guild profile. Please indicate your age group (required)

Less than 25 years old 26 – 50 years old 51 – 65 years old 66 years and better

We Need Volunteers!

We are a volunteer based organization. We cannot exist without member support.

Other ways you can help (please describe below):

Please provide additional information regarding Fibre Related Interests

Privacy Statement

Please read the Privacy statement below and initial in the initial field below

Initials(required)

LDWS Privacy Statement

Current dues: $120 per year (students $60/year)

Please choose your method of payment:(required)

I will e-transfer the amount to: LDWSFinance@gmail.com I will mail payment to:

Donna Martin 14 AMANDA Ave, Mount Elgin On N0J 1N0

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