BECOME A MEMBER!

SHOULD YOU WISH TO BECOME A NEW MEMBER OR SHOULD YOU WISH TO RENEW YOUR CURRENT MEMBERSHIP, SIMPLY CLICK ON THE LINK BELOW TO DOWNLOAD A PDF OF OUR APPLICATION FORM, WHICH YOU CAN THEN PRINT.

PLEASE SEND TO:

DURHAM IRISH ASSOCIATION

P.O. BOX 181, PICKERING, ONTARIO

L1V 2R4


 

DIA - Annual Membership Application & Renewal

Membership Term - 2022 Calendar year

 

 

 

 

 

 

Note: Check this box if there is no change from last year

 

 

 

 

 

 

 

Name

 

 

 

Mailing Address

 

Municipality

Province

Postal Code

 

 

 

Telephone

Cell

 

 

Email

 

 

 

 

 

 

 

Membership Class - Please Circle One

 

Single $25.00

 

 

Family $30.00

 

Name of 2nd member, if family

 

 

 

 

 

 

 

 

 

Please send payment to:

 

 

 

 

 

 

Durham Irish Association

P.O. Box No. 181, Pickering, Ontario, L1V 2R4

 

 

 

 

 

 

 

Office Use

Date Received _____________

Amount Received _________

Payment Type _____________