MI Enrollment Form

Please Submit or Print and Send By Mail

Yes, I would like to become a member of the Militia of the Immaculata (MI).

 

Please enroll me as a MI on this date:
First Name:
Last Name:
Address:
City:
Province/State:
Postal/Zip Code:
Country:
Email:
Date of Birth:
Phone:

 

I learned about the MI from

I wish to support the work of the MI movement with a donation of $  (Thank you!)

 

Additional Comments / Message:

 

Please send your donation as a cheque to:

Militia Immaculata Canada

 

PO Box 22113  RPO Capri Centre
Kelowna, B.C.
V1Y 9N9
Canada

Email: immaculatacanada@yahoo.com