Region of Waterloo Form

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Purchase Region of Waterloo Museums Membership

First Name:

Last Name:

Address: (Street, Apt. No., P.O. Box, R.R. No.)

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Phone number:

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Is this a new membership or a renewal?

New Membership

Renewal

What type of membership would you like to purchase?

Individual Annual Membership - $39 + HST

Family Annual Membership - $67 + HST

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