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Right to Quiet Society
for Soundscape Awareness and Protection
   



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Membership Application/Renewal

Rainbow Line

Yes, I want to join the growing movement against noise pollution and for the recognition of my Right to Quiet. I also want to receive the twice-yearly newsletter. Here are my annual dues for 20__.

The Right to Quiet Society for Soundscape Awareness and Protection is a registered charitable society. All contributions are tax-deductible in Canada, and a receipt for income tax purposes will be sent.

If you live in Canada, please pay by cheque in Canadian funds. If you live in another country, pay the same amount in U.S. funds, by cheque on a U.S. bank or international money order.

Annual dues are payable in January. If you are joining the Society after July 1, you may pay half the amount quoted below.

Single$12.00
Family18.00
Student/Senior/Low-income6.00
Business50.00
Non-profit organization25.00
Additional contribution________
TOTAL  

My additional contribution is $25 or more. Please send me (tick one):

___ Right to Quiet t-shirt, size ________ (Actual size sent depends on availability)

___ "What You Can Do About Noise in B.C." handbook and "I Love Quiet" bumper sticker


My additional donation is $25 or more. Please send me a Right to Quiet T-shirt, size M, L, XL (circle your size). For a picture of the T-shirt click here
Name_______________________________________________
Address_______________________________________________
City_______________________________________________
Province/State_______________________________________________
Country_______________________________________________
Postal/Zip Code_______________________________________________
Telephone_______________________________________________
Fax_______________________________________________
Email_______________________________________________

For more information, please contact:
Right to Quiet Society
#359 - 1985 Wallace St.
Vancouver, B.C.
Canada V6R 4H4

Phone: (604) 222-0207
E-mail: info@quiet.org

If you would like, use the rest of the paper to tell us a bit about yourself or offer other comments.

Rainbow Line

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