HOME  |  PRIVACY POLICY  |  DISCLAIMER  |  CONTACT US
In Winnipeg Call:
204.982.4842
Toll-Free (Manitoba):
1.800.416.6166
Home
Events
Newsletters
Membership - Renew Today
Our Programs
CP Info & Resources
Donate Now

Member Application

Submit Application Payment Options Thank You

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:


Application Type:


Membership Period:

Sep 1, 2017 - Aug 31, 2018

Contact Information:

Name:
Address:
City/Town:
Province:
Postal Code:
Email Address:
Home Phone:
Work Phone:
Cell Phone:

Family Member with Cerebral Palsy (if applicable):

Name:
Gender:
Date of Birth:

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.

Donation Amount:

Name:
Address:
City/Town:
Province:
Postal Code:

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.








OUR MISSION
The Cerebral Palsy Association of Manitoba is dedicated to enriching the lives of individuals affected by Cerebral Palsy through programs, advocacy, education, and peer support.
SITE LINKS
» Home
CONTACT US
Cerebral Palsy Association of Manitoba Inc.
903 - 213 Notre Dame Avenue
Winnipeg, Manitoba, Canada R3B 1N3
Phone: (204) 982-4842 | Fax: (204) 982-4844
Toll-Free: 1-800-416-6166 (Manitoba Only)
E-Mail: office@cerebralpalsy.mb.ca
Facebook: facebook.com/CerebralPalsyAssociationOfMb
Twitter: twitter.com/CerebralPalsyMB
Copyright © 2001-2017. Cerebral Palsy Association of Manitoba Inc. All Rights Reserved.
Privacy Policy | Disclaimer