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MASC Membership/Renewal 2020-2021
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MASC Membership/Renewal 2020-2021
MASC Membership/Renewal 2020-2021
ssagert
2020-02-28T00:00:00-06:00
Please fill in the from below to register your MASC Membership for 2020/2021. 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
Organization Email
Organization Website
Organization Mission Statement
Number of Members as of April 1, 2020
Does your organization have an elected community board?
(Required)
Yes
No
Does your organization have hired staff?
(Required)
Yes
No
#1 Contact Information - Board Member/Staff
Name
(Required)
First
Last
Position
(Required)
Phone
(Required)
Email
(Required)
#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
MASC Membership
MASC's membership year runs from April1 - March 31. The $100 membership fee is due by March 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 and forwarded 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
Hiroc Insurance?
Yes
No
Hidden
Notes:
Number of Visits:
3
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