HPAP-Ontario Membership Survey

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What would you like your membership status to be? *

MEMBER: I am a health provider, endorse HPAP’s mission and values, and will pay an annual membership fee of $25 or PWYC to HPAP-Ontario.

SUPPORTER: I am NOT a health provider; I would like to endorse the statement and join HPAP-Ontario as a supporter.

Name *

City/Town *

What is your health profession? *

How many years have you been involved in this profession?

I am a student/trainee

<5 years

5-10 years

10-20 years

20+ years

I am retired

Other:

Clear selection

What is your email address? *

Do you plan to attend monthly HPAP meetings? *

YES; I will attend by teleconference

YES; I will attend in person (when in-person meeting resumes)

NO; I will receive email updates but not attend meetings

Are there any particular campaigns or issues relating to poverty and health that you are interested in?

How will you pay your HPAP-Ontario membership fee of $25 or PWYC? *

Paypal (visit our website, "Join HPAP/Contact Us" -> "Donate" -> enter $25 or PWYC)

Cash (at a meeting)

Cheque (contact us for mailing address)

Pay What You Can

In addition to my membership fee, I would you also like to make a donation to HPAP.

Other:

Submit

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