Membership Form

Name

Address

Mailing Address (if different from above)

Email

Home Phone Number

Cell Phone Number

Please indicate what kind of Membership you wish to have: (Please note all voting members must be 18 years of age)

Individual Membership Cost $30

Self-Advocate Membership Cost $5

Family Memberships Cost $30

Organization Membership $40

Each of the above memberships comes with:

· All community communication pieces from DSP in electronic format

· Access to all DSP programs and activities (some programs will have an associated fee above and beyond the membership fee)

· One vote at the DSP General Meetings including the Annual General Meeting

Optional information (check what applies):

I have a family member or a member of my household who has Down syndrome

I have a family member with Down syndrome, who lives with me

I anticipate myself or my family / household member will be attending programs / groups / activities offered by DSP.

I consent to receive emails from DSP regarding upcoming events, fundraisers, and programs

I consent to the use of videos / photos on our website, in DSP publications, on social media, and in news media

I consent to the DSP contacting me about programs and special events by text message

What is the age / DOB of your family / household member?

How did you hear about the Down’s Syndrome Association of Peterborough?

Are you or anyone in your family interested in volunteering with DSP?

Yes

No

Not right now, maybe in the future!

If yes, please check off what you are interested in:

Fundraising

Awareness/Education

Programming

Board of Directors/ Board sub committees

Note: If multiple individuals in your family wish to each have a vote in DSP’s General Meetings then each individual needs to purchase a separate membership.