QFHS New Membership Registration 2010/2011
Good from NOW through July 31st 2011

............ Option............ ............ Enter Data or Selected value............
QFHS Membership No.
Names of Member
** Mandatory Fields 		Surname **
Given Name **

Family Membership Yes. No.
Additional Family Member
Address Street Number --- Street Name --- Apartment Number
Line 1 Address **
Line 2 Address
City **
Province or State **
Country **
Postal Code or Zip Code **
Email address

This is required for access to on-line DataBases
 Email address **
Telephone Number(s) Home Phone Number **
Business Phone Number and local/Ext
Fax Machine Number
QFHS is going GREEN
To be environmentally friendly,
the delivery of CONNECTIONS Magazine to be electronic. 		If selected this will commence with the first issue after Jauurary 1st 2011
ANNUAL MEMBERSHIP FEE Individual Membership $65.00
Family Membership $65.00
Donation (enter Value or zero) **
$ 65.00
$.00 **
Proceed to Next Step