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C L A S S I F I E D      S E C T I O N

Carrey3305smallfile.jpg (38320 bytes) Manulife Financial Extended Healthcare Coverage
Health and Dental Plan
DARREN CARREY
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PPGAM MEMBERSHIP APPLICATION FORM (Online Application/Membership Form)

  Date:                                        Member Since:               (year)   I Groom: cats __ dogs __ other __

  Name:                                                 Phone (Home)                      Phone (Cell)                   

  Email:                                           Website:                                                                    

  Address:                                                                                   Phone (Work)                   

  City:                                          Province:                                Postal Code:                  

  Business Name:                                                            Phone:                       Fax:                  

  Service(s) Offered:       Shop:        Mobile:         Both:      

  City:                                          Province:                                Postal Code:                 

  • ___   Annual Membership: $100/year (November 2011 - October 2012)
    • includes Accident Insurance
      Annual Membership: $100/year (November 2012 - October 2013)
      includes Accident Insurance
      Annual Membership: $100/year (November 2013 - October 2014)
      includes Accident Insurance
      Annual Membership: $100/year (November 2014 - October 2015)
      includes Accident Insurance

(  ___  Yes, I would like to receive my Newsletter via email.)

__ I give permission for the PPGAM to provide my information as stated above to other members
within the association on any official PPGAM marketing material.

                                                                                        Signature (in ink)

Online Application/Membership Form

Please make Cheque Payable to P.P.G.A.M.

Mail To:
PPGAM Treasurer
381 Arnold Avenue
Winnipeg, MB.     R3L 0W8

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Or Pay Via PayPal

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Last Updated:

Monday, December 26, 2011