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Richmond Society for Community Living > Surveys  > New Survey

New Survey: RSCL Membership Form

 
Title *
First Name *
Last Name *
Affiliation with RSCL *
Address *
City *
Province *
Postal Code *
Phone *
Email *
I want to receive the RSCL newsletter
Membership Type *
Annual Individual: $10.00 Lifetime Individual: $100.00 Annual Family: $15.00 Lifetime Family: $150.00 An RSCL representative will call you to collect your membership fee and to answer any further questions you may have.
Number of Votes *
Membership *
Monthly Donor Program
An RSCL representative will call you to collect your donation and to answer any further questions you may have.
Application Status
Date Processed
Application Processed By
Payment