Membership Form

Become a Member

It's free to Join!

Please fill out the application below. For assistance or questions, contact Heather at 752-4912 or email

If you wish to fill out and mail please download the Membership Form (PDF)

Name

Organization Name (if representing a group)

Contact Person(s)

Street Address

Mailing Address (if different from street address)

Community

Postal Code

Telephone #

Website Address

Please give a brief description of your organization:

Please indicate your consent to the following by ticking the appropriate box:

listing of my organization's name and contact information on coalition website receiving the coalition's electronic newsletter being added to the coalition's email group, knowing that you may receive information considered 'commercial' in nature, ie., a workshop, event or service for which there is a cost.

You will be involved in the Wellness Coalition by (check all that apply)

Sharing your wellness news and events on Coalition newsletter and bulletins Connecting with other members in the Coalition Acting as a resource person in your area of knowledge Promoting the Wellness Coalition-Avalon East