Clone of The Associated/Affiliated Membership Application Form

alberta cultural society of the deaf Membership Application

September 1, 2025 to August 31, 2026
The associate members (Hearing) shall have no voting rights but shall have the following rights and privileges:

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

-        The right to voice in any discussions.

-        The privilege to serve on any committee of the Society.
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
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.
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 can communicate fluently in ASL or LSQ and/or ISLI read and acknowledge my benefits as an Associate member.
Date of Signature*

MonthDayYear
Date
Signature*

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alberta cultural society of the deaf Membership Application