**** Yes, I believe and support the goals of The Farmlands Trust.
I would like to become an FLT supporter today! ****

Monthly Supporter (please circle):

$5 per month     $7 per month          $10 per month              $_____ per month

Annual Supporter (please circle):

$60 per year           $85 per year           $120 per year            $_____per year

My preferred method of payment is:
m Pre-authorized chequing. Please enclose a cheque marked VOID.
m Cheque. Please make cheque payable to The Farmlands Trust.
m Credit Card: Visa _____ MasterCard _____

Card number ______________________________________________ Expiry Date ____/______

Name on Card_______________________________ Signature ____________________________

My Contact Details:

Name:________________________________________________________________________________

Spouse Name:__________________________________________________________________________

Address:______________________________________________________________________________

City:__________________________________Province:__________________Postal Code:___________

Home Phone:______________________________________________________________________

E-mail:_______________________________________________________________________________
m Please check here if you do not wish to be kept informed of FLT events and activities by e-mail.

Thank-you!

Please return completed form to:
The Farmlands Trust -PO Box 9, Saanichton BC, V8M 2C3.
Or, for immediate service, please call us at: 1-250-483 1468.

for FLT use only - FLT Staff/ Volunteer ________________________________ Date:___________
Site/ Event/Appeal:_________________________________________________ Renewal?___________