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Norwegian Old People’s
Home Association
7725 – 4th Street, Burnaby, B.C. V3N 5B6 Tel (604) 522-5812 • Fax (604) 522-5803
www.normanna.ca
2015-16 Membership Application
(19 Years & Over)
Name(s):
Address:
City/Prov:
Postal Code:
Email:
Home Phone:
Cell Phone:
Please select your membership type

Annual Member $5.00 per person [April 1st 2015 to March 31st 2016]

Life Member $25.00 per person
Please consider making a donation to Normanna Foundation
Normanna Foundation is a registered charity, and relies on donors to help create the unique
quality of experience provided for individuals residing at
Normanna Home
Donation amount: $
Membership:
$
Total:
$
Please note: A tax receipt will
be issued and mailed to the
address provided for eligible
donations only – memberships
are NOT tax deductable
Please make cheque payable to Norwegian Old People’s Home Association and mail it along
with this form to: 7725 4th Street Burnaby BC V3N 5B6

Check if you wish to remain anonymous
For office use only:
Membership Card Issued:_____________
Receipt#_____________
Our Mission
Normanna provides quality residential healthcare services that reflect the values of trust,
respect, caring and diversity.