Organization Application Form
Based on the answers you provided, your organization falls into the General Member category and your annual membership fee is $150. If the fee is a barrier please contact Allyson Theodorou, Operations Manager at 1-866-681-6661 ext. 2.
Please check the following errors
- Please enter name of peer program/organization
- Please enter address of peer program/organization
- Please enter city of peer program/organization
- Please select province of peer program/organization
- Please enter postal code of peer program/organization
- Please select ontario health region
- Please enter website of peer program/organization
- Please enter email of peer program/organization
- Please enter phone of peer program/organization
- Please describe your program/organization
- Please enter name of satellite office location
- Please enter address of satellite office
- Please enter city of peer satellite office
- Please select province of satellite office
- Please enter postal code of satellite office
- Please enter email of peer satellite office
- Please enter phone of peer satellite office
- Select category you would place your organization
- Please enter name of lead organization
- Please enter main contact person name
- Please enter main contact person email
- Please enter main contact person phone
- Please enter email subscriber name
- Please enter email subscriber email
- Please enter email subscriber title
- Please enter email subscriber name
- Please enter email subscriber email
- Please enter email subscriber title
- Please enter email subscriber name
- Please enter email subscriber email
- Please enter email subscriber title
- Please accept terms & conditions
- Please select payment method