2023 Membership - Individual

Individual Membership Registration

To renew or register for a new membership, please fill out the information below.

You will shortly receive a receipt after completing this form. If you require an invoice, please email us at info@nikla-ancla.com.

To pay by cheque, please print this form and mail it with your payment to:

NIKLA-ANCLA

c/o The Blue Mountains Public Library

P.O. Box 580

Thornbury, ON N0H 2P0

Canada

Which Membership are you registering for?

Individual Annual Membership - C$75

Individual Lifetime Membership - C$500

Student Membership - C$0

First Name

Last Name

Address

Where do you work (if relevant)?

Company Position

If you are FNMI, please state your Nation:

What Primary Community are you registering for?

I agree to receive Member messages, including email and blog notices.