Join or Renew Your Balance & Dizziness Canada Membership Today!

To join, please mail a completed membership form and cheque to Balance & Dizziness Canada.

You can either complete and print the application form below, or print a blank form [PDF] and fill it in by hand.

To sign up online via PayPal or Credit Card, please click here.

Untitled Document
Today's date:
Name: Title: (optional)
Address:
City:
Province/State:
Postal/Zip Code:
Phone Number:
Email:
Year of Birth:
Would you consider volunteering?
If yes, do you have any skills/interests you would like to use? For example, phoning members, writing articles, accounting or bookkeeping, legal, admin/office, public relations, fundraising, publicity, computer, or board governance.
How did you hear about us?
Membership:
Donations appreciated: $
Total enclosed: $

*If your membership expires before January 1, 2021, we are offering a $0 COVID relief option to those facing difficulty due to the current economic situation. We hope this will ease some of the burden on our members.

Official income tax receipts are issued annually for membership fees and other donations.
Please make cheque out to "Treasurer, Balance & Dizziness Canada" and mail it along with this printed form to:
Balance & Dizziness Canada
325 - 5525 West Boulevard
Vancouver, BC V6M 3W6
Revised 12/18

Thank you!