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By submitting a membership form, I certify: I am a Canadian Citizen or Permanent Resident of Canada and I am making this contribution with my personal credit card and not a corporate credit card; This contribution is not from a corporation; The funds I am donating are from me and are not being provided by another person or entity for the purpose of making this contribution.

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Print and mail it along with a cheque to: Bay of Quinte Conservative Riding Association
280 Coleman St. Suite 111 Belleville, Ontario K8P 3H7

Please make cheque payable to: B of Q Conservative Assoc.

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