Please join the New Democrats just ll out this form and return to:

Membership Application

New Member Renewal Member number (optional)

5367 Kingsway, Burnaby, BC V5H 2G1 Phone (604) 430-8600 or toll-free 1-888-868-3637 Fax: (604) 432-9517 E-mail: bcndp@bcndp.ca

Please be sure to ll out all sections in the four-step process.

1
Last name

MEMBER INFORMATION
Mr Mrs Ms Dr

Please print and complete in full

Gender

First name

Middle name

Apt

Number - Street - RR # - Site #

PO Box

City or Town ( ) ( )

Postal Code (Required)

E-mail address (For NDP use only. Your address will not be shared.)

Home Phone

Work Phone

If you'd like to receive Newswire - the B.C. NDP e-mail bulletin - sign up online at www.bcndp.ca

Union Member?

Union Membership

Local

I ask that for the purposes of delegate credential entitlement, my membership be considered an afliate membership.

MEMBERSHIP TYPE Please select one of the following options

Pre-Authorized Chequing (PAC) Membership

YOUR MEMBERSHIP CONTRIBUTION

A PAC Membership is always current, so that you can be sure you are entitled to participate in all Party activity. PAC is also the most effective way to support the important work of the Party, because regular contributions allow us to plan for the future. It also means fewer mailings, saving money and paper.

PAC membership contribution I authorize the NDP to debit my account/credit card in the amount of $___________ on a regular basis as follows:
monthly quarterly every six months annually Commencing on the 5th day of ____________ (month), _______ (year) Please attach a void cheque or ll in your credit card information below.

The minimum fee for a general membership is $10. The minimum fee is waived for the underemployed if requested, but a cash fee of some kind is still required.

General Membership

General or YND membership contribution $

Cash Money Order

Cheque (payable to BC NDP)

Credit Card

Please mark this box if the $10 fee waiver is requested, and please enclose the membership fee you can afford. A General Membership remains in effect 12 months from your last contribution to the B.C. NDP. (Please note donations to the NDP of Canada do not renew your B.C. NDP membership.)
A YND Membership entitles you to updates on the activities of the YND. You must be under the age of 26 to be eligible for a YND membership. There is no minimum fee for YND membership, but a cash fee of some kind is required.
Date of Birth

VISA Number MasterCard Number Expiry Date Signature

Ofcial receipt for income tax should be made out to: if same as above check here

Young New Democrat (YND) Membership

Your contribution saves money on your income tax:

Total Contribution $50.00 100.00 250.00 500.00 B.C. Tax Credit* $37.50 75.00 150.00 275.00 Your Actual Cost $12.50 25.00 100.00 225.00

All members are entitled to a subscription to THE DEMOCRAT. If you do not wish to receive your subscription, please mark the following box: I do not wish to receive THE DEMOCRAT

* This gure reects B.C. provincial tax credits. Tax credits can be claimed by anyone who pays income tax. Ofcial tax receipts are mailed out in February of each year. Federal tax credits can be claimed by donating directly to the Federal NDP.

STATEMENT OF AUTHORIZATION

I declare that I accept and will abide by the Constitution, principles, and policies of the NDP of B.C. and of Canada. I am not a member nor supporter of any other political party.
Signature Date

In the NDPs efforts to build and strenghten our party, we are expanding our direct mail program in order to recruit new members and donors. We will occasionally be exchanging our mailing list with other carefully screened, like minded non-prots organizations. This helps us reach new supporters and raise much-needed funds. It is another way you can make an important contribution to the NDPs work on behalf of ordinary British Columbians. If you prefer to have your name removed from lists that are traded with other progressive organizations, please check this box . I do not wish to participate

Canvasser Use Only

Recruiter name Recruiter signature
03/2007 CUPE3787