Adult/Senior (65+) Membership Application Form

ADULT/SENIOR 55+/ASD GRADUATE STUDENT Membership Application

September 1, 2025 to August 31, 2026
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Membership Type*

1 Year Membership - $152 Years Membership - $30
Membership Type*

AdultSeniors (55+)ASD Graduated Student (Free for 2 years)
The active members (Deaf members & Hard of Hearing) shall have the following rights and privileges:

-        The right to vote.

-        The right to receive the official membership publication of the Society.

-        The right to nominate candidates for elective positions.

-        The right to serve on committee of the Society.

-        The right to hold elective office in the Society.
Status of Membership*

NEWRENEWALCHANGE OF INFORMATION
Do you want to subscribe to ACSD Newsletter and any other information about Deaf events through email?*

YesNo
Payment Methods*

E-Transfer – Send your payment to infoacsdoffice@gmail.com. Please include the message: “ACSD Membership [current year] – your name.”Cash or Cheque – Pay in person or mail your cheque to the ACSD office.Debit/Credit Card – You may email your card information, call to process payment over the phone, or visit the office in person. A $2.50 fee applies to credit card payments and a $0.25 fee applies to debit card payments.Fee: Free (ASD graduate student).
Media Consent*

I give permission for ACSD to take and use my photos/videos for promotional purposes (website, social media, etc.)I do not give permission.
Eligibility

I confirm that I am 18 years of age or older.I am Deaf, Deaf-Blind, or Hard of HearingI can communicate fluently in ASL or LSQ and/or ISLI read and acknowledge my benefits as an ACSD member.I read and acknowledge Terms & Conditions.
Should be Empty:

ADULT/SENIOR 55+/ASD GRADUATE STUDENT Membership Application