MASC Membership/Renewal 2020-2021 Please fill in the from below to register your MASC Membership for 2020/2021. Fields noted with the red asterisk are required. Fields that do not apply to your organization may be left blank. New Registration or Renewal* New Registration Renewal Name of Organization* Organization Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Organization PhoneOrganization Email Organization Website Organization Mission StatementNumber of Members as of April 1, 2020Does your organization have an elected community board?* Yes No Does your organization have hired staff?* Yes No #1 Contact Information - Board Member/StaffName* First Last Position* Phone*Email* #2 Contact Information - Board Member/StaffName First Last Position PhoneEmail #3 Optional Contact InformationName First Last Position PhoneEmail Current ActivitiesCurrent activities conducted by your organization. Check all that apply.Activities Health and Wellness Programs Education Programs Social Events Food Programs (congregate meals, special lunches, etc.) Transportation Services Support Groups Other Other MASC MembershipMASC's membership year runs from April1 - March 31. The $100 membership fee is due by March 31 of the membership year. (It is possible to prorate this fee for the first year only.) Cheque is to be made payable to MASC and forwarded to: MASC Membership Attn: C Newman, Executive Director 3 - 203 Duffield Street Winnipeg, MB R3J 0H6Would You Like a Membership Certificate Mailed to You?* Yes No HiddenMASC Admin AreaHiddenHas this Member Paid? Yes No HiddenHas Membership Certificate Been Mailed? Yes No HiddenHiroc Insurance? Yes No HiddenNotes:
