National Anti-Poverty Organization

Membership Application Form

(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.