Member Form

 

    Full Name
    Full Address
    Province
    Postal Code
    City
    Correspondence
    Telephone (Optional)
    E-mail (Optional)
    Date
    I confirm that I am: a qualified elector under the Canada Elections Act (i.e. I am at least 18 years old and a Canadian citizen), and a member of Team Canada and support its application for registration.

    I acknowledge that it is an offence under subsection 408(5) and paragraph 497.1(3)(f) of the Canada Elections Act to make a declaration that is false or misleading. I understand that Elections Canada may contact me by mail to verify the information provided in this declaration.

    Member Signature

    Please prove you are human by selecting the truck.