National Anti-Poverty Organization (Please fill out, print and mail.) First Name: Last Name:
Organization (if applicable):
Address: City: Province: Country: Postal Code:
Phone: Email:
I have enclosed the annual fee of: $
I have enclosed a donation of: $
Enclosed please find cheque payable to the "National Anti-Poverty Organization".
I prefer to pay with my credit card.
Credit Card Type: VISA MASTERCARD Number: Exp:
Signature: _______________________________
I would like to join the NAPO Partner Program by becoming a monthly donor. I authorize the National Anti-Poverty Organization to make monthly withdrawals of: $5 $10 $15 $20 $30 I am able to give $
I have enclosed a blank cheque marked VOID. I understand that this amount will be deducted from my bank account on the first day of each month. I know I can alter or cancel this plan at any time by contacting NAPO. A tax receipt will be issued at the end of the calendar year for the total amount of my annual contribution.
Signature:_______________________________
Please print out and return to: NAPO 2212 Gladwin Cres, Unit C7 Ottawa, On K1B 5N1
Phone: (613) 789-0096 Fax: (613) 789-0141 Toll Free:1-800-810-1076
Membership Categories / Annual Fee
Regular member / $2.00 (one year) $5.00 (3 years) Any person living in poverty or who has lived in poverty.
Associate Member / $50.00 (1 year) Any person who does not live in poverty but would like to support NAPO's work.
Group Member Any group of low-income people or other non-profit organization with an interest in poverty issues.
Total Group Annual Revenue:
Members make the difference. Thank you for your support.
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