Western Front Association
Pacific Coast Branch

Victoria, British Columbia,
Canada.

MEMBERSHIP/RENEWAL APPLICATION 2010

Name: __________________________________________________________________

Address: ________________________________________________________________

City: ___________________________________________________________________

Province/State, Postal/Zip Code: ____________________________________________

Country: ________________________________________________________________

Telephone: ____________________  E-Mail: __________________________________

Annual Membership Fee - $35.00 Cdn/US

 PLEASE ENCLOSE PAYMENT (cheques to "WFA Pacific Coast Branch")

              MAIL COMPLETED FORM WITH YOUR PAYMENT TO:

Mr. Gavin Cooper,

WFA-PCB Treasurer,

7020 Myron Road,

Lantzville, BC

V0R 2H0, Canada.

Tel: (250) 390-2851 dukers6@hotmail.com

Branch Chairman:  Sidney Allinson: Tel: (250) 478-0457 allsid@shaw.ca