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 NameLast Name

3. Organization Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

4. Phone Number

Area CodePhone 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.)

7. Organization Website

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

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

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.

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