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.
First Name*
Last 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

Membership Type*

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

$25.00CAD

Corporate MembershipMinimum $100 donation with tax receipt. If you prefer to offer discounts to inclusion employees, please contact our office.

$100.00CAD

Self Advocate MembershipMembership only. Renews annually on October 1st.

$5.00CAD

Self Advocate MembershipMembership and gift. Renews annually on October 1st.

$10.00CAD

Total

$0.00CAD

Credit Card

Apple Pay

Google Pay

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.
Please verify that you are human*
If you prefer to send in your application and payment by mail or in person, print this form (click the "Print Form" button above) and mail or drop it off at:

inclusion powell river

106-7075 Alberni Street
Powell River, BC
V8A 2C2
Should be Empty:

inclusion powell river Membership Application