Member Application
Please complete the following information to renew or submit a new application for membership. After submitting your application, you will be given the option to make your payment online.
Type of Membership:
Family/Individual - $10.00Business/School/Association - $25.00
Application Type:
New MembershipRenewal
Membership Period:
Sep 1, 2020 - Aug 31, 2021
Contact Information:
Family Member with Cerebral Palsy (if applicable):
Make a Donation, in Addition to your Membership:
All money raised is truly appreciated and stays in Manitoba to support individuals and families affected by Cerebral Palsy.
Use Contact Information Entered Above on Tax Receipt
Consent:
By clicking "Submit Application" below, I consent for The Cerebral Palsy Association of MB (CPAM) to use my mailing address and phone number for the purpose of informing me about upcoming events & activities, to distribute the newsletter or to mail me information regarding Cerebral Palsy or the association. I understand that CPAM will never sell, rent or distribute my personal information. I may withdraw my consent at any time with written notice.