(613) 447-0361 president@ottawaostomy.ca

Membership Form

    Membership Application for Ottawa Support Group - (New & Renew)
    Membership is open to all ostomates, family members, medical and health care professionals, ostomy equipment suppliers and any other interested persons


     
     
    Our newsletters and other communication is done via email. This keeps our costs as low as possible.
    I would like to receive correspondence, including the newsletter, via email? YesNo
    Would you like to receive your newsletter and invoice by email (if you selected "No" above, please select "No" here again): YesNo
     
     
    Check all that apply

    New MemberRenewing Member

    MaleFemaleMD, ET, Supplier, Spouse

    ColostomyUrinary DiversionContinent UrostomyIleoanal PouchIleostomyContinent Ileostomy
     
     

     
     
    Ottawa Support Group Membership: $20.00
    Includes 1 year membership in the Ottawa Ostomy Support Group and our newsletter (9 editions annually)

    Ostomy Canada Society Inc. & Ottawa Support Group Membership: $45.00
    Includes 1 year membership in Ottawa Support Group, a monthly newsletter, membership in Ostomy Canada Society and 2 issues of the Ostomy Canada Magazine (Spring & Fall)

    * Please no post-dated cheques
    ** Please ensure your phone # is on your cheque
    *** Tax Receipt are issued for donations greater than $25
    **** Payment can be sent via etransfer - Please email etransfer@ostomycanada.ca when you send the etransfer with the members name and type of membership (Ostomy Supporter, Ostomy Canada Society or a donation). If you don't, we cannot trace the payment to a member. Also, when making the etransfer, in the comments/notes section of the etransfer, include your name and phone number.
    ***** Please fill out the membership form for contact info and if you are renewing any changes to your contact information and send it onto the membership chair.
    ****** Make cheques payable to Ostomy Canada Society - Ottawa Support Group - 5800 Ambler Dr #210, Mississauga, ON L4W 4J4

    By clicking submit, you agree that you will be subscribed to our newsletter list. You will have the option to unsubscribe anytime. Your information is safe with us and we never share your personal information to any third party. Tax receipt will be provided as on Ostomy Canada Supporter.

     

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