Please Help Support CFAC with Your Membership / Donation

CFAC urgently needs your financial
support to aid in our current campaigns.

Mail / Fax Submission: Please use the printer friendly version of this form to submit your payment by mail or fax.

Phone Submission: Please contact CFAC directly at (403) 295-2159 to make your donation or membership submission.

Online Submission: Please complete the form below and you will be contacted regarding payment for your membership / donation by phone within the next few days.
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Online Submission:

E-mail Address

First Name

Last Name

Street Address

City

Province

Postal Code

Telephone

(please include area code)

NEWSLETTER SUBSCRIPTION
	$25 per year
	Additional Support (optional)
	Indicate amount:
	Total amount:

DONATION ONLY
Amount of Donation:
Designation:
	Use wherever needed most
	Apply towards the cost of the following issue or campaign:

For donations of $25 or more, you will receive a one year subscription to our bi-monthly newsletter.

MONTHLY SUPPORTER

I would like to make a monthly contribution to CFAC. (This can be processed on your credit card or by automatic monthly bank account withdrawal).

Amount of monthly support:

•	IMPORTANT: Please enclose a blank cheque marked VOID for account information.
•	Monthly Supporters call anytime to cancel.

All monthly supporters will receive CFAC's bi-monthly newsletter.

PAYMENT OPTIONS

Once this electronic submission is recieved at the CFAC office, you will be contacted to arrange the payment for your subscription / donation.

Payment options include:

•	Cheque
•	Credit card - Visa or Mastercard
•	Pre-authorized Monthly Bank Debit (Monthly Supporters Only)

For pre-authorized monthly bank debit a blank cheque marked VOID will be required for bank account information. DO NOT send such cheque until you have been contacted by CFAC.

Canada Family Action Coalition
Suite 204, 3639 - 27 Street NE
Calgary, AB T1Y 5E4
Fax: (403) 291-2515