Mahone Islands Conservation Association
Membership Form

I would like to become a member of the Mahone Islands Conservation Association.
(You may join and pay on line directly here, if you prefer.)

Name ___________________________________________

Address _________________________________________

City/town __________________ Prov/State____________

Postal Code ________________ Country________________

Telephone(H)_________________ Telephone(W)___________

email _____________________________________________
(MICA does not share our mailing list with any other party. Your email address is used only to alert you about MICA news and events.)

Organization ________________________________________

Number of members: ____ X $10.00 = $ __________

[    ] I would like to donate an additional
amount toward MICA's efforts:          $ __________

------------------------------TOTAL $ __________

A charitable tax receipt will be issued for all donations other than membership fees. Please make cheque payable to "Mahone Islands Conservation Association". MICA is a Nova Scotia registered society with charitable status.