HELP SUPPORT |
| Membership Form |
| The Friends of |
The Jake Thomas Learning Centre |
| NAME: |
| ADDRESS: |
| CITY: |
| PROVENCE / STATE: |
| COUNTRY: |
| TELEPHONE: (HOME) |
| (WORK) |
| OCCUPATION: |
| DATE: |
| SIGNATURE: |
Membership is $20.00 ending December 31st |
| I would like to make a donation to the: |
| Capital Fund: $ |
| Great Law Fund: $ |
| Total Enclosed: $ |
| ٱ Please send me a receipt. |
| Revenue Canada No. 0999813-21 Ontario Corporation No. 1081361 |