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British Columbia Black Powder Association (BCBPA)
Membership Application
Please Print
Name:_________________________________________________________________________________________
Year of Birth: _________________________BCBPA Members #: __________________________________
Date of Application:______________________________________________________________________________
E-
Mailing Address:________________________________________________________________________________
City:______________________________________ Prov:____________________________________________
Postal Code: __________________________ Phone: __________________________________________
Additional Family Members:
Name: ________________________________________________ Year of Birth: ______________________
Name: ________________________________________________ Year of Birth: ______________________
Name: ________________________________________________ Year of Birth: ______________________
Name: ________________________________________________ Year of Birth: ______________________
Name: ________________________________________________ Year of Birth: ______________________
DUES MAY BE PAID IN ADVANCE
Membership TYpe
Junior: $15.00 Paid________________ Cash _____ Cheque
Single: $20.00 Paid_________________ Cash _____ Cheque
Family: $25.00 Paid_________________ Cash _____ Cheque
New Members: How did you hear about BCBPA
Web Page Trade Show Advertising Friends/Family Other:___________________________
Make Check or Money Orders payable to BCBPA and forward to:
BRITSH COLUMBIA BLACK POWDER ASSOCIATION (BCBPA)
P.O. BOX 78091 PORT COQUITLAM, B.C. V3B 7H5