MEMBERSHIP FORM Canadian Society for Aesthetics NAME: ________________________________________ ADDRESS: _____________________________________ PHONE (work)__________________________________ (home): ______________________________________ E-MAIL: ______________________________________ FAX: _________________________________________ I enclose ____$25, annual or ____$60 for three years membership fee; ____$15, annual or ____$30 for three years, reduced fee for students or those not fully employed ____plus a supporting donation (fees and donations are tax deductible) (US Members: reg. $20 US or $48 US for three years; reduced rate: $12 US or $24 US for three years) Please send to: Mr. Victor Y. Haines 4729 de Maisonneuve Westmount (Quebec) CANADA H3Z 1M3 VYHVYH@cam.org