Hensall Co-op Membership Information Update

Dear Member:

Thank you for updating your Member information.

If you are not yet a member, the application is available here. Please complete the form online. You can print it after it is completed.

Fields marked with * are required.

Membership Information Update

* Member Number
* First Name
Middle Initial
* Last Name
* Date of Birth Please enter your date of birth in the following format MM / DD / YYYY
* Email Address
Telephone Numbers
* Primary Phone
Cell Phone
Mailing Address
Street
City
Province Please type the full province name ( eg: Ontario )
Postal Code