Question Title

* Last Name (required)

Question Title

* First Name (required)

Question Title

* Pronouns

Question Title

* Street Address (required)

Question Title

* Apartment/ Unit #

Question Title

* City (required)

Question Title

* Province (required)

Question Title

* Postal Code

Question Title

* Phone Number

Question Title

* Email (required)

Question Title

* Date of Birth

(to determine membership class)

Question Title

* Membership Class (Required)

Question Title

* Membership Fee (Required)
To pay the membership fees for Class B ($40), you can visit CanadaHelps to make a $40 Donation  or pay in person at the AGM.

Question Title

* Involvement
Tell us a bit about your current and past involvement with the LGBT Youth Line

  Volunteer/Student Placement/Intern Board Member Donor Event Attendee Staff None
Past
Current

Question Title

* If you are a supporter:
If you are a support of the LGBT Youth Line through your work with an allied organization, please let us know which one(s)

Question Title

* Disclaimer and Signature

Question Title

* I certify that my answers are true and complete to the best of my knowledge.
Signature (Required)
Please write out your full name

Question Title

* Date (Required)

Signature date

T