Membership Application Form

Coureurs de Bois - Membership Form

Annual membership is $20 (single or family). A surcharge of $1 will be automatically added. A total of $21 will appear in the shopping cart. Please review the information before submitting.
Select year for annual membership
Are you renewing your membership for the year selected?
How did you find the CdB?
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
E-mail
Home Number
Format: (000) 000-0000.
Cellular Number
Format: (000) 000-0000.
Overall Health
Special Medical or Physical Disabilities
Signature of primary person
Would you like to register a second person residing at the same address?
Register a second person to your family membership
Name of second person

First NameLast Name
E-mail
Cellular Number
Format: (000) 000-0000.
Overall Health
Special Medical or Physical Disabilities
Signature of second person
Enter the message as it's shown
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annual membership + $1 surcharge$21.00 CAD
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Coureurs de Bois - Membership Form