Membership Form

Membership Form
Type of Member *

New Member Renewing Member
Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number
E-mail *
If you have a child with learning disabilities:
Child's Name (optional)
Type of Disability (optional)
Child's Age (optional)
Annual Membership Costs

Individual/Family.....................$30.00 Individual/Family (WITHOUT BINGO VOLUNTEER COMMITMENT)...$50.00
BINGOS: PLEASE NOTE: As our need for BINGO VOLUNTEERS is great, members are required to work a minimum of TWO(2) Bingos per Year to receive a $20.00 DISCOUNT ON MEMBERSHIP.
Reason for joinging

Parent of a child with learning disabilities Adult with learning disabilities Student Professional Supportive Adult Other
Please enter "other" reason for joining here
*Other Volunteer Opportunities

Tutoring Casino Special Events Bottle Drive
*Some volunteer roles require a criminal records check and application process.

CONSENT REQUIRED FOR E-MAILS FROM LEARNING DISABILITIES ASSOCIATION OF ALBERTA - RED DEER CHAPTER.

The Learning Disabilites Association of Alberta values the privacy of its members and will not release your personal information to other organizations. The Learning Disabilities Association of Alberta - Red Deer Chapter gathers information about its' members in order to develop programs and services. Please indicate your agreement to receive e-mails from the Learning Disabilities Association of Alberta - Red Deer Chapter by inserting your name in the signature space below. E-mails will be for program information, fundraising, volunteer opportunities and other information for members only.
Signature
Date

Month Day Year Date Picker Icon
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