2019 Membership Application Form

Thank-you for your interest in joining EIYSA! Our aim is work collaboratively with the community to highlight youth-related initiatives and programming in the city of Edmonton and surrounding areas. Registration grants you full access to our monthly meetings, information on youth activities and exclusive networking opportunities. Additionally, your membership fees help offset EIYSA's administrative costs. Membership is applicable per agency and can be utilized by various staff within your organization.

To apply for membership for your organization, please complete all questions below:

Organization Membership
Cost: $50 per year per organization

* Indicates required fields that must be filled out for the form to work.

1. Organization: *

2. Contact Person *

First Name Last Name

3. Organization Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

4. Phone Number *

Area Code Phone Number

5. Organization Email *

example@example.com

6. May we subscribe the email of the organization (above) to the database for EIYSA's electronic communications? (Note: You can easily unsubscribe at any time.) *

Yes, please subscribe our organization No, we do not wish to subscribe at this time

7. Organization Website

8. May we provide a link back to your organization's website on the EIYSA website?

Yes, please link to our site No, we do not wish our site to be linked

9. Membership Fee: $50 - payable to EIYSA. Please indicate the way you will be making payment on behalf of your organization: *

Cheque - please bring with you to the next meeting Electronic - Make payment via PayPal (Please use the payment button on our website at www.eiysa.ca) We need EIYSA to email us an invoice for payment

10. Payment Instructions: When you click the "Apply for Membership" below, all your answers will be submitted to EIYSA by email and that completes the information collection portion of membership application. In order to fully complete your application, you must make payment as per the option you selected above at #9. *

I have read and understand the payment instructions and after submitting this form, I will follow-up by making membership fee payment.

11. To prove you are not a robot, enter the message as it's shown *