Membership Application for Ottawa Ostomy 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 Your Name Your Email Phone Number Full Address Choosing to receive your newsletter and your renewal notices reduces our mailing costs Would you like to receive your newsletter and invoice by email: YesNo Check all that apply New MemberRenewing Member MaleFemaleMD, ET, Supplier, Spouse ColostomyUrinary DiversionContinent UrostomyIleoanal PouchIleostomyContinent Ileostomy How did you learn about us Ottawa Ostomy Support Group Membership: $20.00 Includes 1 year membership in the Ottawa Ostomy Support Group and our newsletter (9 editions annually) Ostomy Canada Supporter & Ottawa Ostomy Support Group Membership: $45.00 Includes 1 year membership in Ottawa Ostomy Support Group, a monthly newsletter, membership in Ostomy Canada Society and 2 issues of the Ostomy Canada Magazine (Spring & Fall) Yearly Membership Dues: $ Donation for the Chapter: $ Total: $ * Please no post-dated cheques ** Please ensure your phone # is on your cheque *** Tax Receipt are issued for donations greater than $10 **** Payment can be sent via etransfer - Please email treasurer@ottawaostomy.ca when you send the etransfer with the members name and type of membership (chapter membership, ostomy canada support 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 OOSG. Mail to: OOSG: Membership Chair, 274 Moffatt St, Carleton Place, ON K7C 3L3 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 (25.00) will be provided as on Ostomy Canada, Supporter. Δ