Hog Watch Manitoba

Membership Application
Name
Address
Email address
Phone
Fax
Individual member
($25 per person)
Organization member
Name of Organization

Please enter your data in the spaces provided, print it out,
and mail it with your cheque to

Glen Koroluk
Treasurer
Hog Watch Manitoba
#2 - 70 Albert Street
Winnipeg MB
R3B 1E7

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