renew - CARP

1 AND MAGAZINE HALTON CHAPTER I want to renew my CARP membership! 1 year CARP Membership Plus 9 issues of Zoomer Magazine just ..$ 3 year CARP Membership Plus 27 issues of Zoomer Magazine just $ 1 year CARP Membership Only $ : or 3 years for .. $ 9 issues of ZOOMER Magazine $ : or 27 issues $ Payment Options Visa MasterCard Amex Cash Cheque #_____ #CARP Membership Number EXPIRY DATE NAME of member CREDIT CARD# if paying by Credit Card EXPIRY DATE CREDIT CARD HOLDER NAME All of the above information is required.

2 Use the following lines to update/correct any of your personal information NAMEADDRESS CITY PROVINCE POSTAL CODERESIDENTIAL PHONE BUSINESS PHONE EMAIL ADDRESS DATE OF BIRTH dd/mm/yy (optional) SPOUSE/PARTNER NAME Check here if you prefer not to receive any CARP special with your payment to the address below, or hand to a CARP volunteer. HALTON CHAPTER CARP # CH03 TOM CARROTHERS Chapter Chair Phone 905-319-7345 1283 Sycamore Dr., email Burlington ON L7M 1G8 Web renewal RBG