Membership Application Form
Aphasia Nova Scotia (Aphasia NS) is here to support people with aphasia and their families, friends, and colleagues by connecting them to an aphasia-friendly community. To apply to be a member of Aphasia NS (it's FREE), please fill in the information below.
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Personal Information
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Do YOU have aphasia?
Do you have a FRIEND with aphasia?
Are there people in your FAMILY with aphasia?
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If you have APHASIA, rate your current abilities ...
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Interests and Hobbies
What do you do in your FREE TIME?
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Availability for Programs and Events
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Emergency Contact
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Permission to contact by EMAIL?
Occasionally, Aphasia Nova Scotia sends out newsletters and event notices to our members. You can unsubscribe at any time.
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