Membership Application
Alberta Association on Gerontology

Membership Form

	New Membership: ___ Renewal: ___
Name
Organization
Address
Postal Code
Phone	Home:
	Work:
Fax
E-mail
Chapter Affiliation	Edmonton ___
	Calgary ___
Membership Year runs from April 1 to March 31
Type of Membership	Student Senior Individual Organizational	___ $15.00 ___ $20.00 ___ $40.00 ___ $60.00
I am pleased to make a tax donation of $__________
Please advise us if we can print your name in our AAG Mag Newsletter acknowledging yor donation. Yes ___ No ___
Please invoice my organization: ____

AAGMag

The Newsletter of the Alberta Association on Gerontology is published quarterly. All members of the association receive the newsletter.

Complete this form and mail along with a cheque or money order to:

Alberta Association on Gerontology at :
AAG
c/o Education Resource Centre
100A, 1509 Centre Street S.
Calgary, AB  T2G 2E6

Attention: Josette Champagne