ESC New Member Application Form 2018-2019

ESC New Member Application Form

Thank you for your interest in joining ESC. Please submit this form for consideration and we will be back in touch as soon as possible.
Organization Name (Exactly as you want it to appear on the ESC Membership List)*
Type of Organization*

Public / EducationGovernmentNon-profit or charityOther
Agency website*
Street address*
Street address line 2
City*
Province

ON
Postal code*
Telephone*

Area CodePhone Number
Please list any social media addresses you wish to promote through ESC (e.g., Twitter, Facebook, Instagram)
Your Organization's Primary Contact:*
Contact Title or Position*
Contact email address*
Second Organization Contact:*
Contact email address*
example@example.com
Third Organization Contact: (Optional)
Contact email address
example@example.com
Please provide a brief description of your agency, including programs and services provided.
Why would your agency like to join ESC?
Please indicate any ESC services or programs you are interested in, or would like to suggest:
All applications are subject to approval by the ESC Steering Committee. Once approved, applicants will be invoiced for the annual membership fee of $500.00.

If you have any questions about membership, please forward them to info@esc.network.

Thank you for your interest in ESC!
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