Please print out this form or download the PDF or Microsoft Word version and send the completed form to the following address: (Please see below for Payment Information)

By Mail:	First Nations Child & Family Caring Society c/o Suite 302 - 251 Bank Street Ottawa ON K2P 1X3
By Fax:	(613) 230-3080
By Email:	info@fncfcs.com

Yes, I would like to join the First Nations Child & Family Caring Society as a Member under one of the following categories:

	Elder Membership ($5)
	Individual Membership ($75)
	Student Membership with ID ($25)
	Small FNCFS Agency Membership: 1 - 50 employees ($350)
	Large FNCFS Agency Membership: 50+ employees ($600)
	Small Associate Membership: Organizations with 1 - 50 employees ($350)
	Large Associate Membership: Organizations with 50+ employees ($600)

Last Name:
First Name:
Job Title:
Employer:
Program/Year of Study:
Educational Institution:
Mailing Address:
City:		Province:
Postal Code:		E-mail:
Phone:		Fax:

Payment Information:

Please make cheques or money orders payable in Canadian funds to the First Nations Child & Family Caring Society of Canada Inc. and mail along with this form to:

First Nations Child & Family Caring Society of Canada Inc.
c/o 302 - 251 Bank Street • Ottawa, Ontario, K2P 3X1 • Phone: (613)230-5885