HBMO Membership Application



Name:_________________________________________________________________

Address:______________________________________________________________

City:_________________________________________________________________

State/Province:____________________________

Zip/Postal Code:___________________________

Phone: ____________________________________


Membership Class (please check one):

_____ Life Member ($300.00)

_____ Supporting Member ($80.00)

_____ Contributing Member ($40.00)

_____ Educational Institution ($25.00)

_____ Family Membership ($20.00)

_____ Individual Membership ($15.00)

_____ Youth Membership ($10.00)



_____ Life Member (Electronic-only) ($300.00)

_____ Supporting Member (Electronic-only) ($64.00)

_____ Contributing Member (Electronic-only) ($32.00)

_____ Educational Institution (Electronic-only) ($20.00)

_____ Family Membership (Electronic-only) ($16.00)

_____ Individual Membership (Electronic-only) ($12.00)

_____ Youth Membership (Electronic-only) ($8.00)




Please print and complete this membership application and return with a check for payment of dues to:

HBMO Dues
Caroline Staddon
1250 Ferriss Rd.
R.R. #1
Harrow, ON N0R 1G0
CANADA