1116 Waterford Street
Thunder Bay, ON P7B 5R1

Tel: (807) 622-6666   Fax: (807) 622-5100
Toll-free: 1-800-461-9294

 

I/we wish to purchase a membership in Literacy Northwest.  Enclosed is payment for the September 2010 to August 2011 operating year.

Name:

Organization:  

Official Representative (if applicable):  

Mailing Address:  

Postal Code:  

Phone:  

Fax:  

Email Address (if applicable):  

□ Individual Membership:
(over 16 years of age, reside within the service area)		 $25.00
□ Literacy Agency/Literacy Organization Membership:
(operating within the service area)		 $50.00
□ Corporate Membership/Sponsor:
(for an individual, business or organization that wishes to support the work of Literacy Northwest)
Charitable receipts available upon request		 $100.00
□ Associate Member:
(resides outside the service area)		 $25.00
Sector: □ College     □ Community-based    □ School Board □ Other (please specify)
Stream: □ Anglophone        □ Deaf             □ Francophone            □ Native