To become a member of SOS Water COALITION Eau Secours!
Print this form, then fill and send it with your payment by mail 

Given name: 

Surname: 

Address:                                                     appt:

Street: 

City: 

Zip or Postal code:

Phone: (         )      

E-mail:                                   

Sustaining Member:  I have not the time to participate in the coalition’s activities, but would like to financially support it in agreement with its mission.

Participating Member: I would like to be made aware of all the coalition’s activities

Volunteer:   I could dedicate a few hours_____ per month toward “Eau Secours!” activities.  Please contact me.

Annual membership “Eau Secours” membership fees are $ 10.

Find Attached ____________$

I add an extra donation of ___________$

Year :

Month:  

Day: