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A cheque in the amount of $75. must accompany this application which must be submitted by January 31 of each year.

Name: __________________________________________________________

Address: ________________________________________________________

City:_________________________________ Postal Code: ________________

Phone: _______________ E-mail Address ______________________________

Why do you want to become a member of Second Chance Wildlife Sanctuary?

________________________________________________________________

________________________________________________________________

I agree to comply with all rules and by-laws of Second Chance Wildlife Sanctuary. I understand that it is the member’s responsibility to assist this organization by undertaking duties to benefit the organization.

Applicant’s Signature _____________________ Date: ____________________

Please note “membership dues” in memo section of cheque.

Send completed application with cheque to:

Second Chance Wildlife Sanctuary
2060 Concession Road 7
Pickering, Ontario L1Y 1A2

For office use only:  

SCWS No. __________

Date of Issue _____________

Expiration Date ____________________

 Board Member _________________________

Board Member _________________________