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Join Ostomy Toronto!

APPLICATION FOR MEMBERSHIP

Please complete the below form in its entirety and click send. An Ostomy Toronto representative will then contact you to complete your membership application. Thank you.

Full Name *

Address

City

Province

Postal Code

Email Address *

Telephone Number

Type of Ostomy

Colostomy
Ileostomy
Urostomy
Other

Year of Surgery

Age

Languages Spoken

Payment options

Membership is $30 per year for adults and is $30 for 3 years for a Parent/Caregiver of Child with an Ostomy/Youth (18 & under). Once you submit this form, we will call you to collect payment information. Payment can be made by VISA, Mastercard or cheque.

Donation

$
I would like a tax receipt Yes   No

Newsletter subscription

I would like to recieve the newsletter by email Yes   No

Comments

No one will be refused attendance to meetings due to inability to pay dues.
* Required Fields