SBHASA Membership Form

To join or renew your membership, please complete this form & submit with payment via choice of method below.

Membership Fee is $20.00 per year and is valid from January 1st to December 31st of the year you renew. The membership fee applies to all members with Spina Bifida / Hydrocephalus who wish to access the Funding Support Program.

Member Benefits (Individual & Immediate Family only):
- Regular updates from the association including access to resource and educational materials / Monthly Association E-News.
- Invites to social functions/fundraisers for the association.
- Members in good standing will also have access to the association’s funding programs and any scholarship programs available. As a member, you are also automatically a member of (SBHAC) at no additional charge. Memberships not renewed by January 31st each year may not be able to access funding supports. Priority will be given to members in good standing and with a minimum of 6-8 hrs volunteer time. Family or friends who volunteer on the members behalf contribute towards the member’s minimum requirement. *Some exceptions may apply with Board approval.
- **Non paying memberships are not eligible for funding support.
Membership Types & Descriptions:

(All information provided will remain confidential and used only for the purposes of budgeting for our support program a/or events and activities.)

"Individual"

Adult with Spina Bifida / Hydrocephalus ($20 membership fee applies.)

"Immediate Family"

Residing Together i.e. Parent(s) living with child/adult with Spina Bifida / Hydrocephalus. ($20 membership fee applies.)

"Extended Family Member"

Family member of an individual with Spina Bifida / Hydrocephalus but not residing together. This also includes grandparents, cousins etc. You can receive updates on fundraisers, activities, and volunteer opportunities held by SBHASA. (A minimum $20 donation is requested for this type of membership and a tax receipt will be provided.)

"Caregiver"

Professional or non-professional person helping to care for individual with Spina Bifida / Hydrocephalus. You can receive updates on fundraisers, activities, and volunteer opportunities held by SBHASA. (A minimum $20 donation is requested for this type of membership and a tax receipt will be provided.)

"Organization/Corporate/Sponsor"

You can receive updates on fundraisers, activities, and volunteer opportunities held by SBHASA. (A minimum $20 donation is requested for this type of membership and a tax receipt will be provided.)

"Friends & Others"

Friends of members and friends in the community. You can receive updates on fundraisers, activities, and volunteer opportunities held by SBHASA. (A minimum $20 donation is requested for this type of membership and a tax receipt will be provided.)
Please select membership type:*

INDIVIDUAL MEMBERSHIP

We are excited to have you join as a member of SBHASA! Next, we have a couple questions to ensure we can keep in contact with you and keep you updated with all the latest SBHASA news, updates, programs, fundraisers, and social events. Let's get started!
Do you belong to any other disability groups or associations (AISH, CPKids, FSCD etc.). This information helps us to ensure you receive all supports available to you. (If none, please skip this question)

Enter HereEnter Here
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
I have read information provided on this form and understand that I am responsible for volunteering a minimum 6-8 hours per year for the association. Family or friends may volunteer on my behalf and this contributes towards minimum requirement. *Some exceptions may apply with Board approval.*

Yes
Please submit payment for membership by cheque, cash or EFT transfer to sbhasa.info@shaw.ca*

I will mail a cheque or cash to PO Box 6837 Stn D. Calgary, AB T2P 2E9I will forward an EFT transfer to sbhasa.info@shaw.ca for $20I am on AISH and request to have the fee waived for financial reasons
I would like to be kept up to date on the latest SBHASA news, updates, programs, fundraisers, contests, and social events by consenting to receiving SBHASA E-communications at the email provided above.**

YesNo

IMMEDIATE FAMILY MEMBERSHIP

We are excited to have you join as a member of SBHASA! Next, we have a couple questions to ensure we can keep in contact with you and keep you updated with all the latest SBHASA news, updates, programs, fundraisers, and social events. Let's get started!
Do you belong to any other disability groups or associations (AISH, CPKids, FSCD etc.). This information helps us to ensure you receive all supports available to you. (If none, please skip this question.)

Enter HereEnter Here
Name of Child with SB/H*

First NameLast Name
Date of Birth of child with SB/H*

MonthDayYear
Date
Does the Child with SB/H have siblings living in the home? *
Parent's Name(s)*

First NameLast Name
Parent's Name(s)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Secondary Email (Optional) **Please include an email address for any adults with Spina Bifida living in the home.
example@example.com
I have read information provided on this form and understand that I am responsible for volunteering a minimum 6-8 hours per year for the association. Family or friends may volunteer on my behalf and this contributes towards minimum requirement. *Some exceptions may apply with Board approval.*

Yes
Please submit payment for membership by cheque, cash or EFT transfer to sbhasa.info@shaw.ca*

I will mail a cheque or cash to PO Box 6837 Stn D. Calgary, AB T2P 2E9I will forward an EFT transfer to sbhasa.info@shaw.ca for $20
I would like to be kept up to date on the latest SBHASA news, updates, programs, fundraisers, contests, and social events by consenting to receiving SBHASA E-communications at the email(s) provided above.**

YesNo

EXTENDED FAMILY MEMBER MEMBERSHIP

We are excited to have you join as an extension of SBHASA! Next, we have a couple questions to ensure we can keep in contact with you and keep you updated with all the latest SBHASA news, updates, programs, fundraisers, and social events. Let's get started!
Please provide the name of your relative with SB/H:*

First NameLast Name
What is your relationship to the individual with SB/H (please select one):
Your Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Secondary Email (Optional)
example@example.com
I would like to be kept up to date on the latest SBHASA news, updates, programs, fundraisers, contests, and social events by consenting to receiving SBHASA E-communications at the email(s) provided above.* I am also happy to make a minimum donation of $20 (after pressing "Submit" below, you will be directed to a link where you can make your donation. A tax receipt is provided for all donations minimum $20.)*

YesNo

CAREGIVER MEMBERSHIP

We are excited to have you join as an extension of SBHASA! Next, we have a couple questions to ensure we can keep in contact with you and keep you updated with all the latest SBHASA news, updates, programs, fundraisers, and social events. Let's get started!
Are you a professional caregiver or personal?*
Name of person with SB/H whom you help with Caregiving*

First NameLast Name
Your Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Secondary Email (Optional)
example@example.com
I would like to be kept up to date on the latest SBHASA news, updates, programs, fundraisers, contests, and social events by consenting to receiving SBHASA E-communications at the email(s) provided above.* I am also happy to make a minimum donation of $20 (after pressing "Submit" below, you will be directed to a link where you can make your donation. A tax receipt is provided for all donations minimum $20.)*

YesNo

ORGANIZATION / CORPORATION / SPONSOR MEMBERSHIP

We are excited to have you join as an extension of SBHASA! Next, we have a couple questions to ensure we can keep in contact with you and keep you updated with all the latest SBHASA news, updates, programs, fundraisers, and social events.
Organization Name & Location (where applicable)*

Organization NameCity
Do you know someone with Spina Bifida or are you passionate about our cause?*

I know someone with SB/HI am passionate about your cause
Contact:*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Secondary Email (Optional)
example@example.com
I would like to be kept up to date on the latest SBHASA news, updates, programs, fundraisers, contests, and social events by consenting to receiving SBHASA E-communications at the email(s) provided above.* I am also happy to make a minimum donation of $20 (after pressing "Submit" below, you will be directed to a link where you can make your donation. A tax receipt is provided for all donations minimum $20.)*

YesNo

FRIENDS & OTHERS MEMBERSHIP

We are excited to have you join as an extension of SBHASA! Next, we have a couple questions to ensure we can keep in contact with you and keep you updated with all the latest SBHASA news, updates, programs, fundraisers, and social events.
Do you know someone with SB/H or are you passionate about our cause?*

I know someone with SB/HI am passionate about your cause
Your Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Secondary Email (Optional)
example@example.com
I would like to be kept up to date on the latest SBHASA news, updates, programs, fundraisers, contests, and social events by consenting to receiving SBHASA E-communications at the email(s) provided above.* I am also happy to make a minimum donation of $20 (after pressing "Submit" below, you will be directed to a link where you can make your donation. A tax receipt is provided for all donations minimum $20.)*

YesNo
Should be Empty:

"Individual"