(Please print this form and mail with your $100 donation)
 

Wajax Retirees Association          9692 149th Street Surrey, B.C.  V3R 9V3 Phone: (604) 5834567 Fax : (604) 951-2334 grdonald@telus.net

Wajax Retirees Association 1709 Heritage Way Oakville, Ontario  L6M 2Z9 Phone: (905) 827-0419 Fax:  (905) 465-2194 wajaxretirees@cogeco.ca

I wish to support the Association in all their efforts to reclaim the Wajax Pension Plan Surplus for contributors.

Date:_______________                   Email_______________________________

Name_____________________________________________________________

Street Address:_____________________________________________________


City:___________________________ Prov:____________Postal code:________

Telephone:  __________________

Suggestions/Comments:_______________________________________________

___________________________________________________________________


Years of Wajax Service:_____    Year Left:_______   Retired ?_______   (yes/No)

Please make cheques payable to Wajax Retirees Association and mark "In Trust".  All contributions/donations are completely confidential and in a separate "Trust Account" for the purpose of defending our rights.

Revised November, 2004.