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Membership Application Form

December 6, 2007

Please use the form below to sign up and register as a member of Guide Dog Users of Canada. For more information on the difference between Active and Associate members, please see our Membership Overview page.

A $5.00 annual membership fee applies to all members of GDUC. After completing this form, you may pay online with PayPal (or your credit card). Otherwise, a representative will contact you after you submit your application to arrange for payment of your annual dues (valid until December 31 of the current year).

Application Type: *

New member

Renewal

Membership Type: *

Active member (current or former guide dog handler)

Associate member (supporter of GDUC activities)

Personal Information

First Name: *

Last Name: *

Email Address: *

Street Address (Line 1): *

e.g. 141 Rochester Avenue

Street Address (Line 2):

e.g. Apartment 44

City: *

Province: *

Postal Code: *

Phone Number: *

Your Guide Dog

Dog's Name: *

Enter 'n/a' if you have never worked with a guide dog, or 'retired' of your former guide dog has retired.

Dog's Age:

You may leave this blank if you are not currently working with a guide dog.

Dog's Gender: *

Guide Dog School: *

Preferred format for communications from GDUC: *

E-mail

Large Print

Regular Print

Braille

Audio Tape

MP3 CD

How did you learn about GDUC?: *

I plan to pay my membership: *

By using PayPal after I submit this form

By mailing a cheque to GDUC after I submit this form

By remitting my membership through a third party (e.g. another member, board member, etc.)

Other (indicate in 'other comments' below)

Other comments or information:

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