Membership Application

PDACL Membership 'ONLINE' Application Form

General Information: Applications are not complete until membership fee payment, $5 per person, has been received. By completing the form online, it provides a convenient way for PDACL to add your information to our Database. There are two payment options allowing you to choose how you wish to submit your membership fee of $5.00.

You can either: pay online - using PayPal OR submit a Cash/Cheque to PDACL.

For cash and cheque payments, please send to:

Atten: Corresponding Secretary
118 McMillan St., Box 578
Parksville, BC
V9P 2G6

To learn more about membership CLICK HERE. If you have any questions, please contact our Web Team at: Web Team - Form Manager

To continue to the Membership Application Form, click the ' Next ' button at the bottom right of this page. If you need to return to this page, click this link: PDACL Membership Application.

Personal Information

Name and Mailing Information

Given Name(s):

Family Name:

Mailing Address:

Town or City, Province:

Postal Code:

Contact Information

Home Phone:

Cell Phone:

E-Mail Address:

Membership Related Information

Enter Date Here

Are you currently a PDACL employee? I am an employee I am not an employee

Are you a New Member?

PDACL Quarterly Newsletter Preferences:

Demographic Information

The questions in this section are OPTIONAL. Your responses will be used to help PDACL with Succession Planning, development of programs by determining programing needs. This will also allow us to better serve our membership and the participants of PDACL.

What statement best describes you? ie: Parent, Community Member

Age Group of person with developmental disabilities:

What interests you about being a PDACL Member? (200 chars left)

Payment and Security

Form Security Code

Please enter the code:

Payment Options:

Your Membership fee payment, $5 per person, may be made by Cheque/Cash OR online by PayPal. Submit cash or cheque payments to the PDACL Office Atten: Corresponding Secretary,
118 McMillan Street, Box 578, Parksville, B.C. V9P 2G6.

Payment Option: Cash/Cheque paypal

Given Name(s):

Family Name:

Mailing Address:

Town or City, Province:

Postal Code:

Home Phone:

Cell Phone:

E-Mail Address:

Date of Application:

Are you currently a PDACL employee?

Are you a New Member?

PDACL Quarterly Newsletter Preferences:

Payment Option:

What statement best describes you?

Age Group of person with developmental disabilities:

What interests you about being a PDACL Member?

Thank you for completing your PDACL membership application!

Applications are not complete until membership fee payment, $5 per person, has been received. All applications will be presented to the Board at their next scheduled meeting.

If you used PayPal for your membership payment, you will receive an e-mail receipt outlining the payment details. All members will receive a letter of receipt from the PDACL Recording Secretary.

Please feel welcome to download the Constitution and By-Laws - October 2011 and the PDACL Latest Quarterly Newsletter. If you would like access to the 'Members Corner' on the PDACL website, please create a log in (username and password) HERE.