Name:__________________________________________________________(please print)

Mailing Address:_________________________________________________________

_______________________________City:_____________________________

Province/State:__________________________ Postal Code / Zip:_________________

Phone:__________________  Fax: ________________

E-mail ___________________________   Website:__________________________

Membership type:

             Individual  ($30)  ___     Family ($45) ___    Student/ Senior  ($20)  __

                            Supporting ($100) __    Patron ($500+)  ___
            (Note: Supporting Members and Patrons Receive a Income Tax receipt)

Chapter Affiliation ( if applicable)  _____________________________

I would like to have  " The Intuitive Times" delivered by mail. ______________
No thank you, I will pick one up at regular events locally. ________________

I am interested in the Ministry's Group Health Plan. ________________

I would like to make a donation to the Ministry in the amount of _________________
(Donations are tax deductable and a receipt will be issued)

Please complete and return with remittance to: P.O. Box 22018, Charlottetown, P.E.I. C1A 9J2