EFN-CANADA
Membership registration form

You are encouraged to download EFN-CANADA's membership registration form in PDF format for e-mail-forwarding, photocopying and distribution to your friends, colleagues, neighbours and relatives: English version and French version.

EFN-CANADA is a federally incorporated not-for-profit organization. To become a member or a supporter, FILL OUT, PRINT (to paper or PDF file) and RETURN this registration form to:

Environmentalists For Nuclear Energy (Canada) Inc.
c/o Rod Anderson, 1940 Hill 60 Rd., R.R.5, COBOURG ON K9A 4J8, CANADA
Phone: (905) 372-2410 Fax: (905) 372-6274.

E-mail: ca[at]ecolo.org (spam prevention: replace [at] by @)

First name* :

Name* :

Address* :

Postal code* :

City* :

Country* :

E-mail* :

Phone* :

Fax :

Profession :

Age :

years

(*) Required zone  

Please register or update my membership in the following category:

Supporter: I approve your action (FREE - send by fax or PDF file)
Sympathizing Member: CAN $ 50 for one year
Active Member:  CAN $ 100 for one year
Donating Member: CAN $ 200+ for one year.

Welcome as a member or supporter of EFN-CANADA. You will be informed of EFN's activities by e-mail through our mailing list. All dues-paying members receive a confirmation of their registration. New members are admitted subject to the approval of the Board of Directors.

I agree to be a local correspondent of EFN-CANADA in my area:
Additional donation to support the association: CAN $

Total amount: CAN $
paid by: cheque credit card wire transfer
to the order of: "Environmentalists For Nuclear Energy (Canada) Inc."

Date :    Signature:  

  To sign, you can sign the printed paper version if you print this page on paper (in this case please send it by fax or mail), or please type into the "signature" zone your name or any alpha-numerical code legally representing your signature, for example: /John Smith/ or /jsmith8492xfp8902/ if this page is printed to PDF and transmitted by e-mail.

 

 FIRST STEP: fill out, print and send this page to EFN-CANADA

This page should be printed on paper and sent by postal mail (if your membership is paid by cheque) or sent by fax or by e-mail as a PDF file (if your membership is paid by credit card or wire transfer and for Supporters). Click on the "PRINT" button above to print this page or use the "PRINT" button in the menu of your navigating software.

 

SECOND STEP: send your payment to EFN-CANADA by one of the three following methods

Payment by cheque (in CAN $): fill out, print on paper and send this registration form by traditional mail with your cheque. All cheques are to be denominated in CAN $ and must be drawn on a bank located in Canada. If your bank is not located in Canada, preferably pay by credit card (see below).

Payment by credit card via paypal (in CAN $): note the amount to be paid, then click on the visa card logo below, type the amount of your membership in the appropriate box on the next page and follow the instructions. Most credit cards are accepted (Visa, Mastercard, American Express...). The transmission of your credit card number is secured by https protocol.

Note : EFN-CANADA has been incorporated recently and is still in its initial creation phase. The bank account, credit card for EFN-CANADA and the direct payment procedures are currently being set up and will be available shortly. In the meantime any donations made by clicking on "make a donation" button below will be directed to EFN-INTERNATIONAL, which will retransmit the corresponding amount to EFN-CANADA as soon as the administrative procedures are completed. When the final procedures are ready, this paragraph will be deleted and the payments will then be delivered directly to EFN-CANADA (without going through EFN-INTERNATIONAL).

click on the icon : for payment by credit card

Payment by wire transfer (in CAN $): 1- Fill and send this form by fax or e-mail. 2- Send an e-mail asking for instructions concerning payment by wire transfer to ca[at]ecolo.org (spam prevention: replace [at] by @). You will receive instructions by email.

You have the right to access and correct any computerized information about yourself (by writing to the address above).