Burnaby Family Life Institute

Membership Application Form
I would like to:
Purchase a membership for $10
Support a family by making a donation

amount (tax deductible) $

______________
Due to my current financial situation,
I would like show my support and have
a free membership
Pre-Authorized Chequing can be arranged. With one small payment per month you can provide BFLI with a continued ability to provide ongoing services throughout the year.     Please contact our office.

Name:

 ____________________________

Address:

 ____________________________

City:

 ____________________________

Postal Code:

 ____________________________

Phone:

 ____________________________

E-mail:

 ____________________________

You membership and financial support assist us in continuing to provide the services needed to help children, families and individuals in our Community.

Please make your cheques payable to "Burnaby Family Life Institute" and mail your application to:
Burnaby Family Life Institute, #17-250 Willingdon Ave, Burnaby V5C 5E9

Or you may wish to drop off the application to BFLI program staff at any of the following locations:

Burnaby Heights 
250 Willingdon Ave		 Burnaby South
5455 Rumble Street		 Edmonds Resource
Centre
7355 Canada Way		 Metrotown Site
6140 Mckercher Ave
(Across from Sears Metrotown)