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Member No: (This will be your User name/Logon ID)
First Name:
Last Name:
Home/Bus/Cell No: (10 digits, no dashes)
What Province is your Chapter in?:
What Chapter do you volunteer for?:
Intials of your Fundraising Manager?:
E-Mail Address:
Confirm E-Mail:
Enter new password: Max 8 char., lowercase
Confirm new password: Max 8 char., lowercase