Membership Form 2025

Membership Form:

Membership fees are $20.00 per year and are valid from February 1st to January 31
The Spina Bifida and Hydrocephalus Association of Northern Alberta (SBHANA) provides members and their families with a wide range of resources that assist with managing spina bifida and/or hydrocephalus.

A member in good standing with the SBHANA will have access to the Support Fund, Holiday/Christmas Party, NoLimits Peer Support Group, Moms Support Group and Retreat, Camps, voting at the AGM, Walk & Roll BBQ, Sport Try-It Days, Mental Health Program, and our Monthly E-Newsletter.

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
Type of Membership*

Individual (for adults 18+)Parent / GuardianVolunteerSupporter or Organization
Name*

First NameLast Name
Name of person with SB/H (if different than above)

First NameLast Name
Date of birth of person with spina bifida and/or hydrocephalus*

MonthDayYear
Date
Which medical diagnosis do you (or your child) have:*

MyelomeningoceleMeningoceleLipomeningocele or LipomyelomeningoceleSpina Bifida OccultaHydrocephalusN/AOther
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*
E-mail*
example@example.com
Gender of person with spina bifida and/or hydrocephalus

FemaleMaleOther
I would like to be contacted regarding volunteer opportunities at SBHANA*

YesNo
I would like to volunteer for one or any of the following positions:

CasinoFundraisingMember SupportBoard of DirectorsWalk and Roll eventHoliday PartyKMS Smokie saleOther
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.*

YesNo
Is there a program you would like to see SBHANA offer?
Memberships are $20.00 per fiscal year (February 1 - January 31)*

1 Year Membership
Payment Form*

Debit/Credit card - complete the section belowPaypal - complete the section belowE-transfer - send to: info@sbhana.orgPay by Cheque - mail to: SBHANA, #400, 11010 - 101 Street, Edmonton AB T6H 4B9Other
*Please ONLY select this box if you are making payment by Debit/Credit card, or Paypal.
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Yearly Membership
$20.00CAD

Total

$0.00CAD

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Membership Form: