a Turbo Group product
Name:________________________________________________________________
Full Mailing Address:
_______________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
Telephone:___________________________________
Social Insurance Number:________________________
Signature: ___________________________________
Enclosed is $___________ (cheque or money order) for registration of my living will.
Documents to be registered:
_____ Proxy Directive, _____ Instruction Directive, _____ Organ donor information.
Total number of pages: ______
____________________________________________________________________________________
Registry membership is for two years with two year renewals. Costs: (Canadian) $ 54.95 for up to 4 pages, $ 6.95 for each additional page, $ 34.25 for renewals and/or changes of original membership documents.
The North American Registry of Living Wills™ is a service which allows immediate access to advance medical directives for its members in good standing. The Registry reserves the right to revoke the membership of anyone who abuses its services.
©1996, 1997 The Turbo Group, Inc.