Societe Alzheimer Society
Prince Edward Island
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Alzheimer Society of PEI Board Membership
Benefits Include:
• Receive Newsletter
• Receive Notice of Special Events
• Invitation & Voting Privileges at the AGM
Membership: Individuals, companies and organizations may apply for membership in the Corporation.
All applications for admission as members must receive the approval of the Board of Directors. Membership will be determined based on applicants commitment to the philosophy and work of the Society; has, or is prepared to obtain an understanding of Alzheimer’s disease and the impact of the disease on individuals, their families and society; and whether the applicant has a willingness to support the Corporation in its events, fundraising and awareness campaigns By-law 3.01.
Member Information
Name
*
Prefix
First
Last
Suffix
Mailing Address
*
Street Address
Address Line 2
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State / Province / Region
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Zambia
Zimbabwe
Country / Region
Date of Birth (for C.R.A. purposes)
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DD
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YYYY
Phone
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Extension
Cell
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Email
I would like to be notified by
Text
Email
Mail
1. Why do you wish to become a member of the Alzheimer Society of PEI?
*
2. Have you been a previous member of the Alzheimer Society of PEI?
*
Please select
Yes
No
3. If yes, when and in what capacity?
4. When you become a member will you participate in Society fundraising events and/or provide expertise in a specific area?
*
Please select
Yes
No
5. If yes, which of the following interests you?
Advocacy
Finance
Fundraising
Governance
Policy
I understand that I will not be a member until my criminal record check is dropped off, in person, to the Alzheimer Society of PEI at 166 Fitzroy Street, Charlottetown, PE. (Please note we can provide you with a letter so this service is free of charge)
*
I agree
1 Year Membership :
New - $35.00
Renewal - $35.00
We accept: Cash, Cheque, or Credit
Please make cheque payable, and send to:
Alzheimer Society of Prince Edward Island
166 Fitzroy Street
Charlottetown, PE
C1A 1S1
How will you be paying for your membership?
Cheque
Cash
Credit Card
If you selected credit card, please visit our website (alzpei.ca) after submitting this form, click "Donate Now", and under "Apply your donation to a fund set up by this charity" choose "Membership".
Thank you for supporting the Alzheimer Society of Prince Edward Island.
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Alzheimer Society of PEI, 166 Fitzroy Street, Charlottetown, PE C1A 1S1
Phone (902) 628-2257 Email society@alzpei.ca Fax (902) 368-2715