Program Membership Form

To download the Program Membership Form click or tap here or use the button below.

Pacific Riding for Developing Abilities 

1088 – 208th Street, Langley BC, V2Z 1T4 • Phone: 604-530-8717 • Fax: 604-530-8617 www.prda.ca • Business # 11907 5620 RR0001 

MEMBERSHIP FORM

Membership is valid for one calendar year, January 1stto December 31st. The cost is $25.00 per person to purchase or renew a membership for the year. 

Name: _____________________________________________________________ Address: ___________________________ City: ____________________________ Province: __________________________ Postal Code: ______________________ Phone: ____________________________ Cell: ____________________________ Email: _____________________________________________________________ 

Method of Payment (Circle one): 

Cash Cheque (payable to PRDA) Visa Mastercard Credit Card #: ______________________________ Expiry Date: ______________ Signature: _________________________________ Date: ____________________ 

______________________________________________________________________________ 

For office use only 

Date Received: ______________________ Receipt #: ________________________