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Membership Form For PDF version click here
Print this form, and mail or fax to us. Please print your contact information very clearly, or we may not be able to get in touch with you. First Name:____________________________________________________________ Last Name:____________________________________________________________ Organization (if applicable)_______________________________________________ Your Mailing Address (include box number if applicable): Street: ________________________________________________________________ City:______________________ Province/Territory _____________________________ Postal Code_____________ Phone Number: _________________________Fax:____________________________ *Your Email (for news, updates):___________________________________________
Optional. To help give us a good idea of the profile of our Network's membership, would you please provide us with a little extra information. I am: (mark X on all that apply) A Senior ______Service Provider _____ Researcher _____ Educator ___ Clergy ______ Business Person_____ Other ________________________ (please specify)
You can mail or fax your application to: Attention: Charmaine Spencer, Gerontology Research Centre, Simon Fraser University, Room 2800-515 West Hastings Street, Vancouver, BC, V6B 5K3. Fax: (778) 782-5066 Email:
Back to Home Page Canadian Network for the Prevention of Elder Abuse. Paged last updated 28/04/2009.
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Canadian Network for the Prevention of Elder Abuse ~~Réseau canadien pour la prévention des mauvais traitements envers les aîné(e)s
About this Site: For copyright and other information, click here. Contact us, click here. Canadian Network for the Prevention of Elder Abuse.
Page last updated Friday November 27, 2009. Questions? Comments? Contact Webmaster:
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