Supporting Member Application

Document No.

SSISC-FRM-003

Complete the form below to apply for Supporting Membership with SISCC. Your application will be emailed to our membership team and you will be directed to complete your annual membership payment.

Section A

Applicant Information

Full Legal Name*

Preferred Name

Email Address*

Phone Number

Mailing Address

City

Province

Postal Code

Preferred Method of Contact

Phone

Mail

Section B

Connection to SISCC

How do you connect with SISCC's mission?*

Educator or academic

Legal or advocacy professional

Health or social services professional

Community organization

Concerned citizen / ally

Other

Please describe your connection or motivation for supporting SISCC:

How did you hear about SISCC?

Areas where you would like to offer support (optional):

Section C

Consent & Signature

I consent to SISCC storing my personal information for the purpose of membership administration and communication.

I understand that my information may be used in anonymized, aggregate form for research and advocacy purposes.

Signature (Full Name)*

Typing your name constitutes a legal electronic signature.

Date*

SSISC-FRM-003

Survivors of Saskatchewan Independent Schools Coalition

Both consent statements must be acknowledged before submitting.

Survivors of Independent Schools

Coalition Canada

Unit 8B-529

3110 8TH St East

Saskatoon, SK S7H 0W2

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