Membership Application and Donation Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Signature and date

By signing this application, I hereby certify that I am over the age of 18 and am eligible to vote in the Province of Prince Edward Island. Sending this form via email is considered the same as signing.

Comments

Membership

New

Renewal

Donation amount

Youth (18-24 years old): One-year membership: $5 Three-year membership: $10 Adults: One-year membership: $10 Three-year membership: $25

Receipt required?

Yes

No

Note: The form will be sent directly to admin@islandparty.ca; however, funds must be transferred separately via either e-transfer to admin@islandparty.ca (please use Island Party of PEI as the recipient), or mail to PO Box 863, Montague, PE, C0A 1R0. Thank you!

Authorized by the Official Agent of the Island Party of PEI.