MembershipHow would you like to pay for your membership?* Pay Online Pay by Cheque ProfileName* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*FaxEmail* Which best describes you?* Agricultural or forestry producer Rural resident or retired farmer? What type of production do you do? Have you ever been a member of the QFA in the past?*YesNoGST No. 107 867 814 RT 001 – QST No. 100 611 322 9 TQ 001 Total $ 0.00 CAD PaymentPlease enclose cheque payable to Quebec Farmers’ Association. Do NOT send cash in the mail. Receipts are issued upon request. Quebec Farmers’ Association (QFA) 555 Boul. Roland-Therrien, Office 255, Longueuil, QC J4H 4E7PaymentCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name
