Scleroderma Society of Canada

Membership Form

Individuals in Canada become members of regional groups, and these groups make up the Scleroderma Society of Canada. Your membership form will be passed along to the group that is nearest to you. A person from that group will contact you with more information regarding membership. Thank you for your interest and for filling out the form.


first name

last name

your address

City

Province

Postal code

Telephone

Fax no

E-mail address


I am interested in: (check all that apply)
Fundraising Brochure Distribution Telephone Calls Other




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�Scleroderma Society of Canada, Membership Form, 2000-2004.
 Last Update: rdg - FEB 08/04 - Email: [email protected]
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