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MASC Membership/Renewal 2021-2022
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MASC Membership/Renewal 2021-2022
MASC Membership/Renewal 2021-2022
ssagert
2021-04-01T00:00:00-05:00
Please fill in the from below to register your MASC Membership for 2021/2022. Fields noted with the red asterisk are required. Fields that do not apply to your organization may be left blank.
New Registration or Renewal
(Required)
New Registration
Renewal
Name of Organization
(Required)
Organization Address
(Required)
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Organization Phone
(Required)
Organization Email
(Required)
Organization Website
Organization Mission Statement
Number of Members as of April 1, 2021
Does your organization have an elected community board?
(Required)
Yes
No
#1 Contact Information - Board Member/Staff
Name
(Required)
First
Last
Position
(Required)
Phone
Email (If different than the email provided above.)
#2 Contact Information - Board Member/Staff
Name
First
Last
Position
Phone
Email
#3 Optional Contact Information
Name
First
Last
Position
Phone
Email
Current Activities
Current activities conducted by your organization. Check all that apply.
Activities
Health and Wellness Programs
Education Programs
Social Events
Food Programs (congregate meals, special lunches, etc.)
Transportation Services
Support Groups
Other
Other
Other Questions
Please answer the following questions about your staffing and insurance.
Does your organization have hired staff?
(Required)
Yes
No
Number of Full Time Staff
Please enter a number from
0
to
10
.
Number of Part Time Staff
Please enter a number from
0
to
10
.
Do you carry HIROC insurance offered through MASC?
(Required)
Yes
No
Are any of your members/staff interested in Johnson Insurance?
(Required)
Yes
No
Unsure
MASC Membership
MASC's membership year runs from April1 - May 31. The $100 membership fee is due by May 31 of the membership year. (It is possible to prorate this fee for the first year only.) Cheque is to be made payable to MASC. Please ensure your centre/group name appears on the cheque. Forward with this application to: MASC Membership Attn: C Newman, Executive Director 3 - 203 Duffield Street Winnipeg, MB R3J 0H6
Would You Like a Membership Certificate Mailed to You?
(Required)
Yes
No
Hidden
MASC Admin Area
Hidden
Has this Member Paid?
Yes
No
Hidden
Has Membership Certificate Been Mailed?
Yes
No
Hidden
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