Alberta Association of Former MLAs

Membership Form

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Registration Today's Date: Month, Day, Year:

Name:

Constituency last represented:

Mailing address:

Town/City:

Postal or Zip Code:

Email address:

Preferred phone (cell or landline) including area code:

Permission Do you give permission for your contact information to be shared with other Former MLA members?
Yes
No

Membership What term of membership do you want?
One year $50.00
Two years $100.00
Three years $150.00

Visitor Confirmation

please enter the letters as they appear