Group Membership Application

Community Group or Organization Name:*

Example: North End Women’s Centre

Name:*

First Last

Mailing Address:*

Street Address PO Box (if applicable) City Province Postal Code

Email

Organizational/Associate Membership:

Volunteer Opportunities:

Can we call you for volunteer opportunities?

Would you like to receive occasional communications from Manitoba Moon Voices?

Topics of Concern:

Please select all that apply.

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