inclusion Annual Membership Application

inclusion powell river Membership Application

Please note, our membership runs from Oct. 1st - Sept. 30th. Your membership will be due for renewal on October 1st of each year that you are a member.
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

My Products

Individual MembershipMembership and gift. Renews annually on October 1st.

$25.00CAD

Corporate MembershipA minimum $100 donation with a tax receipt is required. If you prefer to offer discounts to inclusion employees, please contact our office.

$100.00CAD

Self AdvocateMembership only. Renews annually on October 1st.

$5.00CAD

Self AdvocateMembership and gift. Renews annually on October 1st.

$10.00CAD

Total

$0.00CAD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

By clicking submit on this form, you agree to receive periodic emails from inclusion powell river related to your membership and other organizational updates. You can unsubscribe at any time.
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If you prefer to send in your application and payment by mail, print this form (click the "Print Form" button above) and mail it to:

inclusion powell river

106-7075 Alberni Street
Powell River, BC
V8A 2C2
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inclusion powell river Membership Application