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Canadian Membership Application

Use this form if you wish to pay for your membership in Canadian Dollars. Fill in all appropriate information, then click the “Create Application” button. Mail the custom generated form with your cheque to the address on the Application. Items marked * are required (if no e-mail or phone, enter 0 or none).

For gift memberships, choose “give a new membership” and the desired category (and other options if appropriate), then fill in your name, address and credit card information (for billing puposes), followed by the mailing information for the recipient.

I would like to start or renew my membership or give a new membership in the following category:

Individual ($75.00)
Individual (2 years: $140.00)
Retired ($65.00)
Student ($45.00)
Institution (School, Church, Library: $75.00)
Donor ($150.00)
Patron ($300.00)
Life ($900.00)

Donors, Patrons, and Life Members help to underwrite the work of The Hymn Society.

($50.00 of the membership dues are for a one-year subscription to The Hymn)
Membership Dues: $
My additional gift to The Hymn Society: $
Amount Enclosed: $

Personal (or Billing) Information:

Name*
Street Address/P.O. Box*
 
City*
Province*
Postal Code*
Phone Number (with Area Code)*
E-mail Address*
Denomination*
 

Gift Recipient:
Name
Street Address/P.O. Box
 
City
Province
Postal Code
Comments or Special Instructions

Please check your input for accuracy then click the button

Note: The custom form generator may fail to work on some systems. If that is the case, simply print this page and mail it with your cheque to:

Sr. Loretta Manzara, CSJ
#24-1138 Kipps Lane
London ON N5Y 5K6