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Print and mail To:
P.O. Box 609 Tofino, British Columbia,V0R 2Z0, Canada,
Tel: (250) 725 4488 Fax: (250) 725 2103
Email to: Tonquin@seaviewcable.net


MEMBERSHIP APPLICATION

Name	..................................................................................................
Address	..................................................................................................
	..................................................................................................
Business Phone	..................................................	Home Phone	.................................................
Email Address	.................................................	Fax Number	.................................................
Contact Person	....................................................................................................................................

Areas of Interest & Expertise ....................................................................................................................................

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	MEMBERSHIP LEVELS (These are minimum rates)
Individual-$30 ~ Supporting-$100
Corporate Bronze-$250 ~ Corporate Silver-$500 ~ Corporate Gold-$1000
Patron-$2000 (minimum)

Please make your cheque or money order payable to:
THE TONQUIN FOUNDATION

I hereby agree to abide by the bylaws and uphold the aims and objectives of the TONQUIN FOUNDATION

.	Signature .......................................................................................
	Date ............................................................