Kootenay Coop Radio Membership Form

By filling out this application, you are pledging to make a payment to Kootenay Coop Radio for the membership indicated below. On the next page, you will have the option to pay by credit card using PayPal. Otherwise, you can mail a cheque to us, or visit us at our studios in Nelson. Either way, we will then give you a membership card, our latest newsletter, and our current schedule.

Use the Send button to email this application to KCR.

Name :

E-Mail Address :

Address:

City/Town/Village:

Province/State:

Postal Code:

Telephone:

Membership Type:
Regular - $45
Fixed income - $25
Family - $80
Organization - $125
Lifetime - $500

New, or renewal?
Renewal
New member

Form of Payment?
Will Mail Cheque to Box 767, Nelson BC, V1L 5R4
Will pay in Person at #308a Hall St. in Nelson
By Credit Card using Paypal