Kirkland Lake Pro-Life

Box 953, Kirkland Lake, P2N 3L1




          I agree with the principles and aims of the Kirkland Lake Pro-Life


  Name:__________________________________________________________________

  Address:_______________________________________________________________

  Town/City:__________________________________________________________

  Postal Code:___________________________

  Email address:_____________________________________________________

  Can you offer your services in any way?

  Telephoning:______ Baking:_____ Delivering:_____ Typing:_____ Photocopying:_____


_______________________________________________________________________________


              FOR OFFICE USE ONLY


  Membership year___________  Date Paid:_______________________ Card Given:_______




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