Mood Disorders Ottawa Membership Form • 613-526-5406 (voice mail)
c/o Canadian Mental Health Association: 311 McArthur Ave, Ottawa, ON K1l8M3
Email address *
I am a *
Membership Type *
I would like a tax receipt for my donation of $10 or more.
First & Last Name *
Your answer
Address (street, City, Postal Code) *
Your answer
Email *
Your answer
Phone Number
Your answer
Please add my email to MDO's confidential electronic distribution list. *
I would like to recieve emails on ... *
How did you hear about MDO?
Your answer
Do you have a mood disorder? Members with mood disroders are eligible for subsidized participation in our Discovery 2000 events. *
Waiver & Release: By completing this form, on behalf of myself, my relatives and guests, I hereby waive, release and forever discharge Mood Disorders Ottawa (MDO) Mutual Support Group, its Directors, Officers, agents, volunteers and employees, and anyone associated with MDO, of and from all manner of actions, causes, suits, debts, claims and demands whatsoever in connection with MDO and Discovery 2000. I assume full responsibility for any injury, accident, damage or harm arising as a result of my participation, and that of my relatives and guests, in all MDO and Discovery 2000 events, activities, programs and services including travel involved in participation. 
I am over the age of eighteen (18), legally competent to sign this waiver, and agree that the terms herein are contractual. I have read this waiver before voluntarily signing it. *
I would like to hear more about getting involved with MDO and volunteering - Special Events Crew, Phoning, Newsletter Editors & Contributors, Facilitating, Trivia Night and more!
Never submit passwords through Google Forms.
This form was created inside of Ottawa City Soccer Club. Report Abuse