To only join the BHCC E-mail mailing list, fill out this first box and hit the submit button at the bottom of the form.

E-mail Address:

If you would like to join the Blue Highlands Citizens Coalition please also fill out the rest of this form.

Name:

Spouse's Name:

Street Address:

City/Town:

Province:

Country:

Postal Code:

Phone Number (optional):

 Please fill out the following if not included in the above (optional):
Fire Number/911 #:    Lot #:
Concession #: Municipality:

Please pick the most appropriate:
Full Time Resident     Part Time Resident     Land Owner     Other (indicate below if possible)

Additional Comments (optional):

Optional - Please contact me about :
Making a Donation     Obtaining a Roadside Sign     Volunteering with the Coalition