Canadian Mental Health Association Colchester East Hants Branch
P.O. Box 1413, Truro, NS. B2N 5V2
Phone: (902) 895-4211 Fax: (902) 895-4027
Membership fee is $5 for each fiscal year from April 01 to March 31
Name: ____________________________________________________________
Address: ____________________________________________________________
Postal code; _____________________________
Phone: _____________________________
Fax: _____________________________
Email: _____________________________
Membership fee: $ ________
Donation: $ ________
If you would like to volunteer with our organization please indicate the skills and experience that you can contribute:
________________________________________________________________________
________________________________________________________________________
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Signature: _____________________________ Date: ________________________ญญ