Membership Application
Mail to:
FVAS
PO Box 4015 Yarrow Stn. Main
Chilliwack, B.C.
V2R 5H8
NOTE: Information provided on this form is considered CONFIDENTIAL
____ New Member ____ Membership Renewal
Membership gives you...
Free Monthly meetings and workshops, access to boardmaker symbols with free laminating, Summer BBQ and Children's Christmas party. Want to preview a book on Autism without having to buy it outright? We also have an INFORMAL lending library amongst our members.
Membership also gives you the possibility of subsidy to summer camp at Zajac Ranch. Membership fees are due in January of each year and you must have been a member of the FVAS the previous year to receive subsidy. Payment received after January of the new year and new membership are not eligible for subsidy to summer camp.
| Name: |
| Address: |
| City, Prov., P.C. : |
| Home Phone: |
| Work Phone: |
| E-Mail Address: |
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| Child with Autism: |
| Siblings: |
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Membership Categories:
__ Student $5.00 __ Family $25.00
__ Low Income $5.00 __ Professional $25.00
__ Individual $25.00 __ Association $100.00
__ Organization/School $100.00 __ Lifetime Member $500.00
__ Donation
Method of Payment: ___ Cash ___ Cheque
For Office Use:
Date Rec'd: _____________ Receipt Issued ___ Card Issued ___ | 
