Society Membership

Thank you for supporting the Alzheimer Society of Alberta and Northwest Territories with your membership application.

Please note membership is a requisite of serving on our board of directors. By becoming a member, you consent to be contacted via email. Memberships will auto renew January 1 of each new year. If you have any questions, or would like to cancel your membership please call 780-488-2266 or 1-866-950-5465
Name*

First NameLast Name
Address*

Mailing Address

Street Address Line 2

CityState / Province

Postal codeCountry
E-mail*
example@example.com
Your Membership matters to us, so Alzheimer Society Alberta and Northwest Territories would like to use your information to keep in touch about things that may matter to you. With your membership, you will receive four Society Newsletters each year. If you would rather not hear from the Alzheimer Society of Alberta and Northwest Territories, you can unsubscribe to our quarterly Newsletters using the checkbox below.

I do not give Alzheimer Society Alberta and Northwest Territories permission to send quarterly Newsletters
Home Number*
Cellular Number
Information collected will not be sold to third parties and is intended for the use of reporting and conducting Society business. Membership information will be shared with Alberta Gaming, Liquor and Cannabis (AGLC) as a requirement of our gaming license. *
Initials required
Signature date
Signature Date*

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Date
Signature*

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Thank you for supporting the Alzheimer Society of Alberta and Northwest Territories with your membership application.