Burnaby Community Connections

Membership Application Form
* required field

All your contact information will be kept strictly confidential.

Member Information:*

Title

(ie. Ms., Mrs., Mr., Dr., etc.)

First Name*

Last Name*

Address*

City*

Postal Code*

Phone Number.*

** Please include your e-mail address - we will not share it with anyone or send you spam. We prefer to communicate via e-mail to save time & money.

I would like to*

	Purchase an individual membership $5 (Note: after you hit submit you will be given instructions on how to pay for your membership online. Cheques should be made out to: Burnaby Community Connections)
	Purchase an organizational membership $45

Burnaby Community Connections is committed to respecting the privacy of our donors. All information collected is confidential. Credit card numbers are used only for donation or payment processing and are not retained for other purposes. We will not share, sell, rent, or lease your personal information to other organizations. Use of donor information will be limited to the internal purposes of Burnaby Community Connections and only to further the purposes of our organization. Click here to see our complete Privacy Policy.