New & Renewal Members Name* First Last UsernameEmail* Enter Email Confirm Email PhonePhone format: (###)###-####Gender*MaleFemaleBirth Date (mm/dd/year)* Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Hearing Level*DeafHard of HearingHearingFirst NationsYesNoDo you have NCCP or Coach Certification?YesNoWhat level for which sport?Sport(s) of Interest:Are you a member of affiliated Association/Club*BC Rockies - Deaf Ice HockeyDeaf BC GolfGreater Vancouver Association of the DeafGreater Vancouver Deaf Curling ClubGreater Vancouver Deaf Bowling ClubOkanagan Valley of the DeafSouth Vancouver Island Association of the DeafWestern Canada Deaf 55+ CommitteeNone of the aboveDo you want hard-copy newsletters and flyers mailed to you*YesNoMedia Release (Photograph & Video Recording)*I understand that photographs, and/or video recordings may be used by the BC Deaf Sports Federation in its general publicity, social media, informational brochures and newsletters, and future promotion for sport activities. (Consent may be withdrawn at anytime upon written notice to the BCDSF office. If you have any questions please email (info@bcdeafsports.bc.ca) )I agree and give permission for the BC Deaf Sports Federation to take photographs and/or video recordings of me (or my child).I do not agree and do not give permission for the BC Deaf Sports Federation to use photographs and/or video recordings of me (or my child).Membership Level*Student (youth - age 18 and under)Student (adult - age 19 and up)AdultWhat school do you go to?*I am renewing my membership before December 31st.NoYesI would like to make a charitable donation {Date: (Tax receipts will be issued for donation over $20.00) Or donate on-line by credit card www.canadahelps.org I want to give to: BC DEAF SPORT and click GO.Student - under 18 Price: $ 0.00 CAD Student - over 18 Price: $ 10.00 CAD Adult Price: $ 20.00 CAD Newsletter Price: $ 10.00 CAD Affiliated discount (adult) Price: -$ 5.00 CAD Renewal discount Price: $ 0.00 CAD Total $ 0.00 CAD Credit Card (skip this step if total value is $0.00) American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. Δ
