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Updated for 2008 - "two for one" deals for Golf Privilege Club® members
 
   Order Form
 


YES! I would like to purchase a 2008
Golf Privilege Club membership for myself or as a gift.
To order you can PHONE us toll-free
at 1-888-566-5864 in Nova Scotia only
or 1-902-443-8141

Sorry no e-mail orders.

 or you can print this form and fax or mail it.
FAX orders to 1-902-445-2573
MAIL to: 
Golf Privilege Club, The Lung Association Nova Scotia 
17 Alma Crescent, Halifax, Nova Scotia  B3N 3E6 

Please send me Golf Privilege Club membership books. 
I understand that I will be billed $50.00 for each book.

Name
Street
Town/City
Province or State
Postal Code or Zip Code
Telephone
Email address (optional)

I'm paying by:  Cheque or  Credit Card
 
Credit Card details: 
Name on Card Card Type Card Number Expiry Date

Visa 
MC 
Amex		 (no spaces)

(YEAR) (MO)