Membership Form

Membership Form:

To join the SBHANA or renew your membership please complete the following form that will automatically be submitted to the SBHANA. Membership Fee is $10.00 per year and are valid from February 1st to January 31 of the year you renew.
Spina Bifida and Hydrocephalus Association of Northern Alberta (SBHANA) provides members and their families with a wide range of resources for that assist with managing spina bifida and/or hydrocephalus. As a member of the SBHANA you will have access to support from the SBHANA office, educational materials, the latsest news from the the medical community and information relevant opportunites. A member in good standing with the SBHANA will have access to the associations Support Fund ($1,000/year), Christmas Party, NoLimits Adult Grioup, New Parent Gift Bag, events and the SBHANA Monthly E-News.

For more information about any of the services that SBHANA provides please contact the SBHANA office at info@sbhana.org or call 780-451-2921

You will automatically become a meber of the National Organization
Type of Membership *

Individual Family Member Care Giver Grandparent Organization
Full Name *

First Name Last Name
Childs Name

First Name Last Name
Address *

Street Address

Street Address Line 2

City Province

Postal Code
Phone Number *

Area Code Phone Number
E-mail *
Person with spina bifida and/or hydrocephalus *
Childs Name
Date of birth of person with spina bifida and/or hydrocephalus *

Month Day Year
Date
Gender *

Female Male Other
I would like to be contacted regarding volunteer opportunities at SBHANA *

Yes No
I would like to volunteer for one or any of the following positions:

Special Events Fundraising Committees New Member Support Assist with Social Media/Webpage Board of Directors
I would like to be kept up to date on the latest SBHANA news, updates, programs, and social events by consenting to receiving SBHANA E-communications. *

Yes No
Is there a program you would like to see SBHANA offer?
Memberships are $10.00 per calendar year *

1 Year Membership 2 Year Membership 3 Year Membership 4 Year Membership
Please submit payment by cheque or ETF transfer to info@sbhana.org
Payment Form

Pay on Line using Square Pay by E-Transfer to info@sbhana.org Pay by Cheque Other
Signature

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Please verify that you are human *
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Membership Form: