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W.S.P.C.R. Membership Application Form
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To: W.S.P.C.R. (604) 51-WSPCR (519-7727)
6200 Mckay Ave. Box 625 www.wspcr.com
Burnaby, BC, Canada info@wspcr.com
V5H 4M9
First Name ______________ Last Name _____________________
Address__________________________________________________
Province ______________ Postal Code ________ - _________
Country ____________________
Male Female Birthday ______________________
Phone (_______)_____________ E-mail _____________________
Website: ________________________________________________
I hereby apply for membership in the Westcoast Society
for the Protection and Conservation of Reptiles.
I enclose the payment for the chosen type of membership
(please check one):
Individual - $ 25 Family - $ 30
Out of Canada - $ 30
Date _______________ Signature __________________________
My Additional Info:
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Currently I own these animals: __________________________
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Specific Interests:
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Amphibians Turtles Lizards Snakes
I would like to help out in a committee: Yes No
Examples: field trips, conservation, shows, lectures,
education committees.
How did you hear about us? _____________________________
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