(Just hit print on your browser to print this form.)

Name: _____________________________________
   
Address: _____________________________________
   
   _________________     Postal Code:________
   
Phone (H): ______________ (W): _______________
 
E-Mail: _______________________________________

Category of membership (please circle choice):

Individual $25 Senior $15
Family $30 Patron $50
Student $15 Corporation $75

Please make out and forward payment to:

Heritage Ottawa
2 Daly Avenue
Ottawa, ON K1N 6E2

Add any comments on the print form here: