Change or Update Membership Information

Name*

First Last

Co-op Number*

Partial SIN

Middle 3 digits

Birth Month and Date

Partial SIN and Birthdate are requested for verification purposes. If you elect not to provide this information, Peninsula Co-op will contact you to verify your identity before changes to your membership can be made.

Contact Phone Number*

Choose the Types of Information to Change*

Update Name
Update Mailing Address
Update Email Address
Update Phone Number
Update Email Preferences
Add Email Address

New Name*

New First Name New Last Name

Document Upload*

Accepted file types: gif, jpeg, jpg, pdf, png, png, Max. file size: 10 MB.

First or last name changes require a copy of one legal document (ie. drivers license, marriage certificate, etc.). Accepted file types include GIF, JPEG, PDF and PNG. Files cannot exceed 10 MB in size.

New Address*

Street Address City Province Postal Code

Previous Address*

Full address including Postal Code

New Email Address*

Confirm New Email Address*

Previous Email Address*

New Phone Number*

Previous Phone Number*

This field is hidden when viewing the form

You are not currently subscribed to our mailing list. If you would like to be, please check Subscribe and complete the remaining form fields.

Subscribe

Current Email Address*

Verify Email Address

New Email Address

Verify New Email Address

This field is hidden when viewing the form

Untitled

Important member info
Co-op promos & offers
Liquor promos & offers (must by 19+)
Online voting for Directors Election

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.