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Membership Application

Please complete this form and submit it.

Name(s): 

Company: 

   

Street: 

City: 

Postal Code: 

Home Phone: 

Work Phone: 

Fax: 

Email: 

   
Category Fee
General (choose one)  
     Consumer/Client FREE
     Individual $20.00
     Family (indicate who this is below) $40.00
            
   
Associate (choose one)  
     C.M.H.A staff $20.00
     Non-Profit Organization $50.00
     Corporate $100.00
   
Payment  
Fees:      Donation:      Total:
   
  Cheque enclosed (payable to C.M.H.A./Peel)
  VISA and Mastercard
   
Memberships are annual, from April 1 - March 31, and apply to the provincial and national levels of C.M.H.A.

(Memberships purchased after October 31st will be valid until March 31st in the following fiscal year. i.e. A membership purchased November 1, 2008 will be valid until March 31, 2010.)

   
Please take a few moments to complete this Member Survey:
   
  What issues are you interested in or concerned about?
 
   
  Do you know someone affected by a mental health difficulty or illness? How have you coped?
 
   
  How can we best serve you? Have we helped you in the past?
 
   
  What do you expect from your membership?
 
   
  Do you have any questions or comments?
 
   
Your membership enables us to:
  • Demonstrate to funding organizations and policy makers that there is community support for mental health and our services
  • Send a message to our clients that their health is important
  • Promote mental health more broadly
Thank you!
   
I do not want to be on a C.M.H.A. general mailing list.
   
Please enter the letters as seen above before submitting: