Enrollment Form – Militia of the Immaculata Canada

MI Enrollment Form

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

Date Enrolled

First Name

Last Name

Address

City

Province/State

Postal/Zip Code

Country

Date of Birth

Phone

I learned about the MI from

I wish to support the work of the MI movement with a donation of $

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