Clone of Adult/Seniors (65+) Membership Application Form

Affiliated/liaison assocations Membership Application

September 1, 2025 to August 31, 2026
Name*

First NameLast Name
Name of Organization?
Membership Type*

AffliiatedLiaison Associations
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
Status of Membership*

NEWRENEWALCHANGE OF INFORMATION
The affiliated/liaison associations shall have to following rights and privileges:

-        The right of the representative to vote.

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

-        The right of the representative to serve on committee.

-        The right of the representative to hold selective office in the Society providing he/she is Deaf or hard of Hearing.
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.
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 Affiliated/Liaison Associations member.I read and acknowledge Terms & Conditions.
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Affiliated/liaison assocations Membership Application