I want to join by printing the form below and mailing it in together with a cheque or money order.
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RIGHT TO DIE SOCIETY OF CANADA
Telephone ______ - ______ - _________
Cell ______ - ______ - _________
I enclose a cheque or money order, payable to Right to Die Society of Canada, for
__ $30 (Regular-rate annual membership, single)
__ $40 (Regular-rate annual membership, couple or family)
(Cut the above amounts in half if you also belong to another death-with-dignity group)
__ $_____ (Special-circumstances reduced rate -- please add a brief note below:)
__ $_____ (Regular rate plus a gift, to help fund reduced-rate memberships for people with extremely low income or assets)( ) I want to be in contact with other members in my town or city or region
Right to Die Society of Canada
145 Macdonell Ave.