Membership Signup Procedure

To start your membership registration, please fill in the form below.

In order to be a member of the Pirate Party of Canada, you must either be a Canadian Citizen, or a Permanent Resident of Canada.

Membership costs $10 per year and can be renewed automatically.

Membership fees are not eligible for a tax receipt.

Payment can be made by credit card, PayPal, cheque or money order.

First name:
Middle name:
Last name:
Country:
Address:
Address 2nd line:
Address 3rd line:
City:
State / Province:
Zip / Postal Code:
Email:
Phone number (1):
Phone number (2):
Fax:
Automatically renew:	Yes No

Additional contribution Max.: 1200$ (optional):