Application for Membership

I __________________________________________________
(print full name)

of __________________________________________________
(street address)

________________________________________________________           (807)_____________________
     (city, town, village)                          (province)                           (postal code)                               (telephone number)

wish to become a member of Northwest Funeral Alternative Inc. I agree with their objective of providing to members, when they have a death in their family, the simple, lower cost service they want, which does not include embalming, cosmetic restoration or display of the deceased.

I understand that their Basic Service will include obtaining the necessary medical certificate(s) and Burial Permit; assisting in the arrangement of a committal or memorial service if desired; removing the deceased from the hospital in a simple container provided by Northwest, and transporting it to the cemetery or crematorium.

I am willing to follow the regulations of the Corporation and will pay the price in effect when I use its services, I understand that the Basic Service charge is presently (effective Sept. 18, 2001) within the limits of the City of Thunder Bay, and does not include the Lifetime Membership Fee, newspaper notice, Coroner's fee, cremation, extra vehicle (if required), cemetery, storage costs, or GST.

As an applicant, I understand that their service extends to my spouse and dependent children, if any; and that each person covered under a membership may vote at a meeting of the members.

Any jewellery or personal property is the responsibility of next-of-kin or executor, not Northwest.


______________________________           _________________
(signature of applicant)                                     (date)


USE THE FOLLOWING SPACE TO LIST ALL OTHERS TO BE INCLUDED IN YOUR APPLICATION
(e.g., spouse, dependent children). Please state their full names and addresses.

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Copyright Northwest Funeral Alternative Inc. 2005