Friends of Freedom International

MEMBERSHIP & DONATIONS

US Operations
The Friends of Freedom International
2981 Ford St. Extension
Suite 153 Ogdensburg, NY, USA
13669-3474

Canadian Operations & Head Office
The Friends of Freedom International
P.O. Box 22100
Bellevlle, Ontario, Canada
K8N 5V7
Phone: (613) 771-1797
Fax: (613) 771-1435
E-mail: myrights@friendsoffreedominternational.org

Yes, I'd like to become a member!

First Name:

Last Name:

Business / Organization:

Address:

City:

Postal Code:

Province/State:

Country:

Home Phone:

Work Phone:

Fax:

E-mail:

Our Basic Annual Membership Fee

Total to Remit

Individuals $25.00 *

Family $45.00 *

Health Professionals $100.00 *

Retailers & Organizations $200.00 *

Manufacturers & Distributors $500.00 *

(plus extra donation)

* Plus GST at 5% (Canada Only) GST on $25 = $1.25, $45 = $2.25 $100 = $5.00, $200 = $10.00, $500 = $25.00

Enclosed: $

Date:

Card Type

Name on Card

Card Number

Expiry Date

Canadian Operations: Office: C/O Tuck's Business Centre 444 Dundas St. E. Units H & I Belleville ON, Canada K8N 1E9		US Operations: Office/Mailing: 2981 Ford St. Extension Suite 153 Ogdensburg NY 13669-3474
Mailing: C/O Tuck's Business Centre P.O. Box 20144 Belleville ON, Canada K8N 5V1
Contact Us: Phone: 613-771-1797 / Fax: 613-968-3215 Email: myrights@friendsoffreedominternational.org Websites: www.friendsoffreedominternational.org www.healthcanadaabuse.com

Yes, I'd like to become a member!
First Name:
Last Name:
Business / Organization:
Address:

City:
Postal Code:
Province/State:
Country:
Home Phone:
Work Phone:
Fax:
E-mail:

Total to Remit
Individuals	$25.00 *
Family	$45.00 *
Health Professionals	$100.00 *
Retailers & Organizations	$200.00 *
Manufacturers & Distributors	$500.00 *
	(plus extra donation)