Contact Information

Mr.Mrs.Ms.Miss.Dr.

First Name*

Last Name*

Organization (if applicable)

Residential Address

City

Province

Postal Code

Home Phone

Work Phone

Mobile

Your Email (required)

Referred by

Membership Type

One Year Membership ($10.00)Four Year Membership ($25.00)

Make a donation to the NPA

$10.00$25.00$50.00$100.0Other

Other donation amount, please enter in box below.

Please remember your total amount (membership + donation, if you decide to make one) when paying either through PayPal or Credit Card. You will see a "Buy Now" button once you hit send below which will redirect you to the PayPal payment processing page. Please enter the number on that page.

Payment Type

CashChequeCredit Card/PayPal

*Please make your cheques payable to "NPA Vancouver"

I hereby apply for an NPA Vancouver membership. I am a Canadian Citizen,over 18 years of age and a permanent resident at the address listed above. I, or a member of my household, have paid my own membership fee. I am not a member of any other civic party in Vancouver. I understand that I am applying for membership in the NPA and that I will not be a Member unless my application is accepted by the NPA Vancouver Board of Directors and its Membership Committee. I further understand that the NPA reserves the right to refuse any membership application, or renewal of membership, should it feel to do so in the best interests of the NPA and is under no obligation to disclose any confidential or other discussions regarding my application. I hereby consent to the collection, use and disclosure by NPA Vancouver of the personal information set out in this application which allows the NPA to communicate with me at my mailing address, email and telephone number.

Leave a Reply