You must have JavaScript enabled to use this form. To become a member of the Active Living Alliance for Canadians with a Disability, an organization needs to complete and submit the following Application Form.If you haven’t already, we suggest that you read the Becoming a Member section.Membership is reserved to organizations (national, provincial, territorial and community organizations, agencies and municipalities) who, as part of their mandate, are dedicated to the wellness of people with a disability through active living, sport and recreation. Your Organization Organization Name * Membership Type Organization Street Address * Street Address Line 2 City * Postal Code * State/Province * Country * Canada Your contact details. First Name * Last Name * Email * Phone Number * Phone Number 2 Authority to apply * I confirm that I have the authority to apply for membership to the Active Living Alliance for Canadians with a Disability on behalf of my organization (official name stated above). Yes No Display Organization Name? * I agree to have our Organization Name listed alphabetically in the Members section of the Active Living Alliance website. Yes No Link to website * I agree to have our organization name linked to our website. Yes No Your website URL * Submit