HMA Membership Application

First Name

Last Name

SELECT MEMBERSHIP TYPE SELECT MEMBERSHIP TYPEAnnual Membership (Individual) - $20Annual (Family) - $30Life Membership (Individual) - $150Life Membership (Family) - $250

Contact Number

Please enter the names of additional family members in the family

Street Address

CITY CITYBurlingtonHalton HillsMiltonOakvilleWaterdown

PROVINCE PROVINCEOntario

Zip Code

Email Address

Any Notes to Administrator

I confirm that I am 18 years or older, and I am a resident of Halton Region or the village of Waterdown.

I agree the Halton Malayalee Association's Privacy Policy

I agree the Halton Malayalee Association's Terms and Conditions