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Patriot Party of Canada Application for Membership Membership is open to anyone, 14 years-old or older, who is a resident of Canada and belongs to no other federal political party. Please enclose a personal cheque for $10.00 Canadian Mr/M Mrs/Mme Ms/Mlle Dr Other Adult Youth English/Anglais French/Francais Other First Name Last Name Address/Adresse City Province  AlbertaBritish olumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuébecSaskatchewanYukon Postal Code Residence Phone: () - Business Phone:    () - Fax:                      () - Email: Occupation  Accounting/Finance Computer related (other) Computer related (Internet) Consulting Customer service/support Education/training Engineering Executive/senior management Farmer General administrative/supervisory Government/military Homemaker Home Based Business Manufacturing/production/operations Professional (medical, legal, etc.) Research and development Retired Sales/marketing/advertising Self-employed/owner Student Tradesman/craftsman Unemployed/between jobs Other Comments : Optional Information Computer system you use?  PC Mac Unix Other Operating System you use  Windows 98 Windows 95 Windows NT Linux (You will be contacted shortly with more information and a form for your signature) To obtain form in Text format   MS Word E-Mail patriotparty@bellnet.ca

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