Name:________________________________________________________Phone______________________

Address_______________________________________________________

email: ________________________________________________________

New Membership?___________or Renewal of Membership #_______________________________________

If new membership, how did you hear about A.I.M.________________________________________________

Do you wish to be put on the volunteer list for any of the following? 

• Hospital Visitation _________
• Bike Storage &/or pickup _________
• Helping out at events____________

Print this form and send with Membership fee ($20 per person OR $30 per couple) to :

A.I.M. Vancouver Island,

PO Box 998, Stn A,

Nanaimo, BC

V9R 5N2

Total Enclosed $______________