Menu
Home
Services
Tools & Resources
News
Support
About
MPF
Contact
Donate
Returns to Home page - Spinal Cord Injury
Home
Services
Tools & Resources
News
Support
About
MPF
Contact
close
A+
A
-
test-form
MEMBERSHIP APPLICATION
All members receive the ParaTracks newsletter, voting privileges at the Annual General Meeting, and discounts at Stevens Home Health Care Supplies, The Access Store, Northland Home Health Care and Fido Mobile.
Personal Information
Name
First Name:
Last Name:
Company Name (if corporate):
Email Address:
Address
Street Address 1:
Street Address 2:
City:
Province:
Country:
Postal Code:
Donation & Payment
I am a:
New Member
Returning Member
I wish to select the following category of Membership:
MEMBER $15-24
SUPPORTING MEMBER $25-99
SUSTAINING MEMBER $100-249
CHARTER MEMBER $250-499
PATRON MEMBER $500 and over
Donation Amount:
Payment Type:
Credit Card
Debit
Card Number:
Expiry Date:
CVV:
Important:
By signing above, you are consenting to the use of your personal information (name and address only) by SCI Manitoba for the purposes of sending out SCI’s newsletters, membership cards and receipts, renewal reminders, meeting notices and other SCI Manitoba correspondence. SCI Manitoba does not sell or trade personal information and does not rent out its mailing lists.
Submit
Please enter your username and password.
username
password
If you have lost your username or password,
please contact your administrator.
Contact
Feedback
Paratracks
SCI Manitoba FeedbackForm
Notice: JavaScript is required for this content.
This form is currently undergoing maintenance. Please try again later.
Donate
Subscribe To Our Newsletter
Stay up to date with the latest news and information from SCI Manitoba.
SUBSCRIBE!
You have Successfully Subscribed!