Membership Application
Mail completed form and make check or money order payable to
Neighbours Alliance of North York
and send to: Pleasant Valley Heritage
Farm
1059 Route 8
Nashwaak Bridge, NB E6C 1X5
Attention : Kimberly Cuppens
Yes, I am interested in becoming a
supporting member of
Pleasant Valley Heritage Farm. (Check the membership you
prefer below)
____ I would like a tax deductible
receipt.
____ I do not need a tax
deductible receipt.
___ Basic Membership,
$25.00 per year
___ Gift Membership,
$25.00 per year
___ Active
Membership, $100.00 per year
___ VIP Membership,
$250.00 per year
(VIP members only)
___ please send the PVHF pewter
ornament
___ do not send
the PVHF pewter ornament
My name:
______________________________________________
My complete address:
______________________________________________________
My phone number:
________________________________________
My email address:
________________________________________
If a gift membership please
indicate the:
Name of receiver:
________________________________________
Address:
_____________________________________________________
Phone number:
___________________________________________
Email address:
___________________________________________
Please indicate that the gift was
given by:
_____________________________________________________________
