North Saskatchewan Independent Living Centre - Individual Membership Application
* Membership renewal invitations will be sent each year
* Memberships are valid for the current calendar year (January 1st to December 31st)
* Open to any person. This entitles the member to vote and have full speaking rights. Those 18 yrs and older are eligible to hold office.
Date of Application: *
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DD
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Full Name: *
Your answer
Address: *
Your answer
Email Address: *
Your answer
Phone:
Your answer
Are you: *
Name of Guardian (if applicable):
Your answer
Do you authorize NSILC to contact you re: yearly membership renewal and information/activities that may be of interest to you? *We do not release your information to outside agencies* *
If you have a disability, would you like information/assistance to start your own business? *
Would you like information pertaining to:
Would you be interested in information regarding volunteer opportunities?
Your comments/ideas/feedback are appreciated:
Your answer
How did you initially hear about NSILC? *
Your answer
237-5th Avenue N. Saskatoon, SK S7K 2P2 Phone: 306-665-5508 Email : admin@nsilc.com www.nsilc.com
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