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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:
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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



P.O. Box 21003,
314 Harwood Ave. South,
Ajax, ON. L1S 2J0
 

Phone: 416-465-9466
Fax: 416-465-9468
Email: immaculatacanada@yahoo.com



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