b'Date: MEMBERSHIP APPLICATIONOntario Prospectors Association 941 Cobalt Crescent Thunder Bay, ON P7B 5Z4 Tel.: 807.622.3284Toll Free:866.259.3727 Fax: 807.622.4156 Website: www.ontarioprospectors.com Email: admin@ontarioprospectors.comPayment may be made by VISA, MC or Cheque in the amount of $60.00 (HST included) VISA NumberExpiry DateMC NumberExpiry DateCard HolderSignature Please forward payment along with completed application to: Ontario Prospectors Association 941 Cobalt Crescent Thunder Bay, ON P7B 5Z4Name: Company:Mailing Address:City:Province:Postal Code:Phone: Fax:Email:@ ***EMAIL IS THE METHOD OF COMMUNICATION*** IF YOU DO NOT WANT TO RECEIVE EMAIL COMMUNICATION CHECK HERE I wish to be affiliated with the following Regional Prospectors Association(One Regional Association is included with your membership; Other associations may be purchased for $20.00/per association)BOREAL PROSPECTORS ASSOCIATION (BPA):Northern OntarioNORTHERN PROSPECTORS ASSOCIATION (NPA): Kirkland LakeNORTHWESTERN ONTARIO PROSPECTORS ASSOCIATION (NWOPA): Thunder BaySAULT & DISTRICT PROSPECTORS ASSOCIATION (SDPA): Sault Ste. MarieSOUTHERN ONTARIO PROSPECTORS ASSOCIATION (SOPA): BancroftSUDBURY PROSPECTORS & DEVELOPERS ASSOCIATION (SPDA): SudburyNON AFFILIATED'