Name (first): ____________________(Last)______________________
Address : _________________________________________________
City : ______________ Prov. : __________ Postal Code : ___________
Phone#(Home): _______________Phone#(Work): ___________ Fax#: ____________
Donation Amt : $________
Please Mail to:
Canadian Chinese Kuo Shu (Martial Arts) Federation
5030 Maingate Drive, Unit 14, Mississauga, Ontario L4W 1N5
Teleplone: (905) 602-5026
Please make cheques payable to: Canadian Chinese Kuo Shu Federation
Thank you for your support !