Professional Documents
Culture Documents
Membership Form English
Membership Form English
MEMBER!
65 Brunswick Street
Fredericton, NB
E3B 1G5
1-800-561-4009
BECOMING A MEMBER...
In becoming a member, I am in
agreement with the mandate and
governing principles of AIDS New
Brunswick:
Mandate
AIDS New Brunswick is a provincial
organization committed to facilitating
community-based responses to the
issues of HIV/AIDS. The aim is to
promote and support the health and
well-being of persons living with and
affected by HIV/AIDS and to reduce
the spread of HIV/AIDS in New
Brunswick.
BENEFITS TO YOU!
SIGNATURE_________________________________________________________________________
NAME______________________________________________________________________________
ADDRESS___________________________________________________________________________
CITY___________________
PROV_________ POSTAL CODE___________________________
PHONE (H)_____________ (W)_______________ (FAX)________________________________
E-MAIL_____________________________________________________________________________
I would like to make a donation in the amount of $________ (a charitable tax receipt will be issued)
Cheque/Money Order MasterCard Visa
Card # ______________________________
Expiry Date: _____________________
MEMBERSHIP APPLICATION
I wish to become a member of AIDS New Brunswick. There is no membership fee :
Individual
Associate
Professional Assoc. Corporate
I am a person living with HIV/AIDS and/or a volunteer of AIDS New Brunswick