membership application form

DLP Barbados (Canada) Inc.
www.dlpbarbadoscanada.com
PO Box 30088 Hawthorne, Milton, ON L9T 0L8  Tel: 416-287-8291  E-mail: [email protected]
MEMBERSHIP APPLICATION
Last Name:
First Name:
Middle Initial:
Address:
City:
Province:
Phone Number (Home):
Postal Code:
(Cell):
(Business):
E-mail:
Age:  16-29
 30-39
 40-59
 Over 60
Citizenship:  Barbadian
 Canadian
Occupation:
Political Affiliations (in Barbados):
Other Affiliations (Barbadian Associations/Organizations):
I do hereby apply for membership of the Democratic Labour Party of Barbados through its branch, DLP Barbados
(Canada) Inc. and agree to abide and support its Principles, Policies and Programs. My membership fee of
CAD$30.00 is enclosed.
Dated at
this
day of
, 20
Signature of Applicant
Proposed by:
Address:
City:
Province:
Dated at:
this
Signature of Proposer:
Postal Code:
day of
, 20 ___________
Approved:
Secretary, DLP Barbados (Canada)
FOR ADMINISTRATIVE USE ONLY – DEMOCRATIC LABOUR PARTY
 Approved
Date Application Considered:
 Declined
Notes:
Contact Information Added to Membership List:
Signature of Presiding Officer:

Email Address Added to Distribution List: 
Date: