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Please print this form and mail
| Membership effective for 12 months from date joined | NEW ____ RENEWAL ____ DONATION _____ | |||
Chapter
Joining : VANCOUVER VANCOUVER CHAPTER PO BOX 74670 Vancouver B.C.V6K 4P4 |
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| $40.00 Family Membership____ | $80.00 Professional Membership____ | |||
| $200.00 Organizational Membership ____NAME OF ORGANIZATION______________________ | ||||
ENCLOSED IS MY CHEQUE
FOR $______ |
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| I
am interested in ADHD as a: ___parent ___ doctor ___ patient ____ teacher ____ mental health professional ____ other __________________ |
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| I
heard about CH.A.D.D . through: ___________________________________________
I believe I can help in the following ways:___________________________________________________________ |
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| Your Name _______________________ Occupation _________________________________ | ||||
| Address ______________________________________________________________________________________ | ||||
| City _______________________________ Prov___ PC____________________ | ||||
| Tel/day : ____________________ Tel/eve :_____________________ | ||||
| Fax ______________________ E-mail ____________________ | ||||
| *CH.A.D.D. reserves the right to disapprove or cancel the membership of anyone engaging in activities contrary to CH.A.D.D.'s mission, objectives, policies or welfare. CH.A.D.D. Canada does not necessarily share or endorse any statements presented in the literature it furnishes or the meetings or events which it may organize or with which it may be associated and will not be held responsible in any manner for any prejudice or damage suffered as a result of such statement or involvement. No person should rely on any such statement or involvement and should consult a physician or other health care professional for appropriate advice. | ||||
| SIGNATURE ________________________________ DATE __________________________________ | ||||