| DATE | ___________________________________ |
We invite you to become one of our founding members:
| _____ | Living lightly: | $10 (students, seniors, limited income) |
| _____ | Individual: | $25 |
| _____ | Family or household: | $35 |
| _____ | Business or organization: | $50 |
| _____ | Supporter: | $100-400 |
Please consider supporting our new organization as one of our major founders:
| _____ | Steward: | $500 and above |
| Name | ____________________________________________________________ |
| Address | ____________________________________________________________ |
| Postal Code | _________________ |
| Phone | _______________________ |
| E-mail* | _______________________________________________ |
Please print this form, fill it out and send it to:
The Gulf Islands Alliance
P.O. Box 795
Salt Spring Island, BC V8K 2W3