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GYMHA MEMBERSHIP APPLICATION FORM
Please kindly fill out the relevant section as they apply to you
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Name of Individual *
*
First
Last
Date of Birth
*
Email
*
Address
*
Gender
*
Male
Female
Phone Number
*
Marital Status
Married
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Membership in Category
*
Ordinary Membership
Associate Membership
Individual Membership
Please indicate your core profession by checking the below boxes
*
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Comments or Questions
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CATEGORY OF MEMBERSHIP
ORDINARY MEMBERSHIP:
An Organization whose primary objective is either Mental Health/Humanitarian and whose aims and activities are consistent with the statement of purpose of GYMHA
ASSOCIATE MEMBERSHIP:
An Organization with an interest in Mental Health issues (but this is not being their primary focus) and whose aims and activities are consistent with the statement of purpose of GYMHA
INDIVIDUAL MEMBERSHIP:
Individuals who abide with GYMHA statement of purpose
*PLEASE NOTE:
In accordance with the GYMHA constitution, associate and individual members do not have voting rights. The annual membership fees for ordinary, associate and individual members shall be determined from time to time.
* * * PLEASE NOTE : DO NOT PROVIDE PAYMENT AT THIS TIME * * *
Notification of payment ($10.00 p.a) options will be issued to approved applicants once their membership has been formally ratified by the GYMHA Board.
I acknowledge that prior to signing this application I have read and agreed with the constitution and rules of the GYMHA. I also acknowledge that I am in agreement with the statement of purposes attached to it. In the event of admission to the Association
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