Citizens With Disabilities - Ontario Membership Application
Required Required Question(s)
Progress: 
 

Count me in!  I would like to join Citizens With Disabilities - Ontario.
 

Type of application
New
Renewal

The following information is for our records only.  We will not sell or share your information without your consent.

 
Required

 

Please enter the information indicated below.
First Name:
Last Name:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

 

In what form would you prefer to receive CWDO information or updates?
Email
Large Print
Telephone
I will check your website myself at www.cwdo.org
Other  

What are your interests?
Aging with a disability
Arts and culture
Assistive devices
Attendant services
Accessibility
Education
Employment
Housing
Mental health
ODSP/Income security
Recreation
Transportation
Other  
Required

Are you a person with a disability?
Yes, I am a person with a disability and/or
I am close to someone who has a disability

What is the general category(ies) of disability you are interested in?
ADD/ADHD
Agility
Brain injury
Chronic pain
Hearing
Intellectual disability
Learning disability
Mental health
Mobility
Speech
Stamina
Vision
Other  

Are you applying for membership with CWDO as an association, club, organization or disability-related busineses interested in furthering the full participation of all persons in the social, economic and political life of their communities?

 
Yes
No