All-Access Membership Registration (Eco-Champion, Voting)

Please fill out the short form below to begin the membership registration process. A $25.00 membership fee can be paid (preferably) via Credit Card in the form below, via AutoDeposit Interac E-Transfer to borealcentre@gmail.com, or via mail to: PO Box 285, 6055B Centennial Rd, West Moberly Lake, BC, V0C 1X0.

Name *

First

Last

Email *

Username *

Password *

Password

Confirm Password

Bio (Optional)

Phone (optional)

Address (optional)

Address Line 1

Address Line 2

City

State / Province / Region

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Discount Code

If you have already purchased a membership in person, enter the discount code we've emailed you.

Renew Membership Annually? *

• Yes
• No

Regular Membership (1 year, Non-Voting)

Price: $ 25.00

Stripe Credit Card *

Card

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