Award Transfer Form

Please transfer my awards to:
Alberta NWT Branch
Saskatchewan Branch
Manitoba Branch
Ontario Nunavut Branch
Quebec Branch
Nova Scotia Branch
New Brunswick Branch
Newfoundland Labrador Branch
Prince Edward Island Branch

Your Current Personal Details * = Required

Gender: *	Male Female
First Name: *
Last Name: *
Date of Birth: * (eg. 05/21/1970)
E-Mail Address:

Your Membership #

Membership #:	if known [bottom right corner of any Lifesaving Society wallet card]
Membership2 #:	If you have 2 membership numbers put the second one here

Your Current Address

Street Address: *
Sub Address:
City: *
Prov/Ter: *
Country: *
Postal Code: *

Your Current Contact Information

Telephone #: *
Fax #:

All information collected and transmitted by this form is subject to the Lifesaving Society BC & Yukon Branch PRIVACY STATEMENT.

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