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 who in good standing and have met required 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 / Immediate Family" (RESIDING ON ONE'S OWN OR TOGETHER AT SAME ADDRESS)

Adult with Spina Bifida / Hydrocephalus or Parent(s) living with child/adult with Spina Bifida / Hydrocephalus. ($20 membership fee applies.)

"Extended Family Member" (NOT RESIDING AT SAME ADDRESS AS INDIVIDUAL WITH SB/H)

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 (non-family member) 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.)

"Friends, Organizations & Others"

Friends of members and other community supports. 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 / IMMEDIATE FAMILY MEMBERSHIP

(RESIDING ON ONE'S OWN OR TOGETHER AT SAME ADDRESS)

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!
Name of Individual with SB/H*

First NameLast Name
Date of Birth for Individual SB/H*

MonthDayYear
Date
Are you a parent/guardian member living with the individual with SB/H?*
1st Parent's Name

First NameLast Name
2nd Parent's Name (Optional)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Alternate Phone Number (optional)
Please enter a valid phone number.
Email*
example@example.com
2nd Email (Optional - (we recommend providing an email address for both the individual with SB/H as well the parents)
example@example.com
3rd Email (Optional)
example@example.com
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
Are there any other children/siblings living in the home? *
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

EXTENDED FAMILY MEMBER MEMBERSHIP

(NOT RESIDING AT SAME ADDRESS AS INDIVIDUAL WITH SB/H)

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

FRIENDS, ORGANIZATIONS & 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 / Business 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
2nd 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 / Immediate Family" (RESIDING ON ONE'S OWN OR TOGETHER AT SAME ADDRESS)