Join the Alliance

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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 *

Street Address *

Street Address Line 2

City *

Postal Code *

State/Province *

Country *

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

Display Organization Name? *

I agree to have our Organization Name listed alphabetically in the Members section of the Active Living Alliance website.

Yes

Link to website *

I agree to have our organization name linked to our website.

Yes

Your website URL *

CAPTCHA

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