Membership Application Form

    The fields marked with an * are required








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    I am on


    I am interested in volunteering with this organization * (Select one)

    If YES, which Committees/work are you interested in? (Select as many as you would like)



    (Please note: Because we are not yet a registered charitable organization or foundation, we are unable issue tax-deductible receipts at this time)
    Sent via
    If donating by cheque, please, make payable to "Fibromyalgia Association Canada and mail to:
    Fibromyalgia Association Canada
    The UPS Store PMB#161
    5844 Malden Rd, Unit #140
    Windsor, ON N9H 1S4



    Signature - By signing your name electronically (type in your name) on this Membership Application Form, you are agreeing that your electronic signature is the legal equivalent of your manual signature