Name *

First Name

Last Name

Declaration: I identify as Black, African Canadian, or from a racialized community. I am at 18 years of age or older. I normally reside in the province of Ontario. I affirm my interest in furthering the Corporation's purposes. I will pay the annual membership dues, that being Adult: $10 / Youth $5. I understand that such dues will be payable by me each year upon written notice of the board of directors of the Corporation. I confirm that the above information is correct and acknowledge that there is no reason why I may not be considered as a member of Durham Family And Cultural Centre. I also pledge to support the Mission and Vision of Durham Family And Cultural Centre and by my participation in activities, to contribute to the success of the Organization.. *