General Membership Application Form
Help Fill A Dream provides hope, help and happiness for Vancouver Island and the Gulf Islands’ children under the age of 19 with life-threatening conditions by fulfilling their Dreams, improving their Quality of Life and assisting their families with care and financial support
Thank you for your interest in becoming a General Member!
General Member Contact Information
Unit D - 4085 Quadra St.
Victoria BC V8X 1K5
T: 250-382-3135 | TF (BC Only): 1-866-382-2711
F: 250-382-2711
helpfilladream.com

Please complete the following information and should you have any questions, please email: contact@helpfilladream.com or call: 250-382-3135
First Name *
Last Name *
Address *
City of Residence *
Province *
Postal Code *
Contact Phone number *
Email *
Company / Employer (if applicable)
Position
Area of Expertise / Knowledge / Special Skills
How did you hear about Help Fill A Dream *
Why do you want to be a General Member? *
Terms of Agreement for General Member(s)
I understand that my acceptance as a General Member with the Help Fill A Dream Foundation will be at discretion of the staff of the Help Fill A Dream Board of Directors.

CONFIDENTIALITY: I will respect confidential information that I am given regarding the organization and persons involved, including clients, volunteers, donors, staff and others.

PRIVACY: Help Fill A Dream collects information from you for the purpose of determining Membership eligibility. The information collected is treated as confidential and is only disclosed for the above purpose. By clicking "I agree" below, you give consent to use the information as specified above.
I have read and agree with these guidelines *
*
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of Help Fill A Dream. Report Abuse