Kootenay Co-op: Membership Application and Changes

Membership Application:

Please apply for a new membership in person at the Co-op.

Changes To Your Membership:

You may update your membership information using the form below.

Required fields are marked with an asterisk (*)

*Name:
*Membership Number:
*Mailing Address:
*Postal Code:
*Phone Number:
Fax:
*Email:
Driver's License Number:
Name(s) of additional household member who will use this membership:
	Enter the code shown in the image:

Kootenay Co-op

The Kootenay Co-op Country Store
295 Baker Street , Nelson BC Canada V1L 4H4

Phone: 250-354-4077 Fax: 250-354-4097 Email: customerservice@kootenay.coop