Annual Membership Application / Donation Form

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Annual Membership Application Form
South Vancouver Community Crime Prevention Society
(Fillable version 2012-June-01)
5657 Victoria Dr., Vancouver, BC V5P 3W2
Tel: 604-717-2940 Fax: 604-327-2902
Website: www.southvancouvercpc.com Email: [email protected]
The South Vancouver Community Crime Prevention Society (SVCCPS) operates as the South Vancouver Community Policing Centre,
where community members and businesses can meet and work with the police in a non-crisis environment to address crime and safety
concerns. Help us reduce and prevent crime in your community by becoming a member of the SVCCPS or giving a monetary
donation. All membership applications are subject to Board’s approval.
For Individual/Family /Student Membership
Renewal
New Application
Current SVCPC Volunteer?
YES
Name (First Last)
Address
City
Prov.
Postal
Tel.
Email
Contribution Details
Annual Membership
Additional Donation
Renewal
New Application
Business Name
Contact Person Name
Address
City
Prov.
Postal
Tel.
Email:
NO
Please check 
Individual ($15)
For Business Membership
Your contribution today
Family ($25)
Student ($10)
Business ($50)
Total Enclosed:
Cash
Cheque(*)
* Please make cheque payable to South Vancouver Community Crime Prevention Society
An official tax receipt is to be issued during the applicable tax year when the membership fee is received.
Charitable Organization Registration Number #89531-5075RR0001]
Date of Application:
Signature: _______________________________
$
$
$
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