Membership

 

Home Member Groups

   Welcome to the SSAH Provincial Coalition !

Our Mission ... We are a coalition of individuals, families, organizations, associations and agencies dedicated to ensuring that families in Ontario receive the meaningful support they require through 
the Special Services at Home Program and the Passport Funding Program.

 

                     

 

 

Membership Form:


To become a member of the SSAH Provincial Coalition, please print this form and fill it out.


Make cheque payable to BDACI and send your fee along with this form to :
SSAH Provincial Coalition
c/o 2495 Parkedale Ave., Unit # 4
Brockville, ON   K6V 3H2 


Please print this Membership form and send to the address above with your fee.

Name:   _________________________________________________________

Address:   _______________________________________________________

City & Postal Code:   _______________________________________________

Phone number:  ___________________________________________________

Email Address:  ___________________________________________________

Region Office:    ___________________________________________________

Family Member Fee or Individual Fee - $     5.00
Organization or Agency Fee $ 250.00 - $500.00

 
       Copyright  2003 -2012  SSAH/Passport Provincial Coalition