Membership Form

Print this form, complete it and mail it along with your cheque or money order to:
Alberta Association on Gerontology (AAG)
Attn: Lynne Mansell
#300, 10216 - 124 Street
Edmonton, AB T5N 4A3

  New Membership: ___ Renewal: ___
Name
  
Organization
  
Address

 

 
Postal Code
  
Phone
 Home:
Work:
Fax
  
E-mail
  
Chapter Affiliation
 Edmonton ___ Calgary ___
Membership Year runs from April 1 to March 31
Type of Membership
Organization
Individual
Student
Senior

___ $60.00
___ $40.00
___ $15.00
___ $20.00
I am pleased to make a tax donation of $__________
Please advise us if we can print your name in our AAG Mag Newsletter acknowledging your donation.
Yes ___ No ___
Please invoice my organization: ____

AAGMag

The Newsletter of the Alberta Association on Gerontology is published quarterly. All members of the association receive the newsletter.

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