Home 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 Province Postal Code

Phone

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

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

First Last

Membership Categories

People Supported by Community Living

Price:

Free!

Individual

Price: $ 5.00 CAD

Family

Price: $ 10.00 CAD

Corporate

Price: $ 50.00 CAD

Donation(Required)

I WISH TO MAKE A DONATION (A tax receipt will be mailed in the amount of the donation).

Yes

Amount

If desired.

Total

Credit Card

Please check if you have activated a Stripe feed for your form.

THANK YOU FOR YOUR SUPPORT

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Membership Registration

Membership Categories

THANK YOU FOR YOUR SUPPORT

Learn more about our services

Start today & get involved with us.

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