Thyroid Foundation of Canada

Thyroid Foundation of Canada
Membership Form

Awareness - Support - Research

YES! I WILL JOIN THE THYROID FOUNDATION OF CANADA!

Thank you for choosing to support the Thyroid Foundation of Canada by joining or renewing your membership. Your membership helps us to continue our programs of Awareness, Support, and Research.

Members receive Thyrobulletin, TFC's official newsletter.

Please choose one:
New membership Membership renewal Donation only Gift membership Other

PERSONAL INFO (as it will show on your receipt)

Title:

First Name:

Last Name:

Address:

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City:

Province/State:

Country:

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Telephone:

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Required fields

MEMBERSHIP:

Members receive Thyrobulletin, TFC's official newsletter, and have access to our Juste for Members area of the website.

I would like to sign up for Just for Members (your password will be emailed to you)

MEMBERSHIP LEVEL:

One Year:
Regular $35 CAD Seniors (age 65 and over) $30 CAD Family $45 CAD

Two Year:
Regular $60 CAD Seniors (age 65 and over) $50 CAD Family $65 CAD

DONATION:

Add a Donation: All donations support the work of the Thyroid Foundation of Canada

$25 CAD $50 CAD $100 CAD Other $ CAD

General Donation (all donations support the work of the Thyroid Foundation of Canada)

In Memory of:

In Honour of:

RECEIPT:

An official receipt for income tax purposes will be sent automatically to your email address for all membership fees and donations. (BN: 11926 4422 RR0001)

PAYMENT:

We are the Face & Voice of Thyroid Patients in Canada

Membership Amount: $0.00

Donation Amount: $0.00

Total Amount: $0.00

Thyroid Foundation of Canada
P.O. Box 298
Bath ON K0H 1G0
CANADA

Tel: 1-800-267-8822

An official receipt for income tax purposes will be issued for both membership fees and donations.
(BN: 11926 4422 RR0001)

Thank you for your support.

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