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9
Membership Registration
Membership Registration
For the Membership Year Ending March 31, 2023
Name
(Required)
First
Last
Address
(Required)
Street Address (Box # and/or Civic #/County Road/Street Address if in the rural area.)
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
Email
As a feature of our Membership you automatically become a member of Community Living Ontario Membership Listing. Do you approve of Community Living – Stormont County giving your name, address and telephone number to C.L.O?
(Required)
Yes
No
Membership Categories
People Supported by Community Living
Individual
Family
Corporate
Membership Categories
Family Membership
(Required)
For FAMILY MEMBERSHIP please list those residing at above household: (all residents 18-years-of-age and older will be issued a Membership card). All Members Receive C.L.S.C. Mailings
I wish to register additional people.
This is a single registration
1
First
Last
2
First
Last
3
First
Last
4
First
Last
Support Community Living Glengarry
Donation
(Required)
I WISH TO MAKE A DONATION (A tax receipt will be mailed in the amount of the donation).
Yes
No
Amount
If desired.
Total
Credit Card
Feed Required: To use the Stripe field, please create a Stripe feed for this form.
THANK YOU FOR YOUR SUPPORT
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