Membership Renewal Form 2023-24

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Membership Renewal Form 2023-24

If you are a returning Member, please fill out the form below to confirm your Membership with The Ontario Association of Distress Centres, currently operating as Distress and Crisis Ontario. Membership fees are due by April 30, 2024, and payment information is below.

Organization name: *

Primary Contact Name: *

Title:
*

City:
*

Province:
*

Postal Code:
*

Phone Number: *

Email Address *

What are the phone, chat, and/or text services you offer (please include the name of the service, phone number(s), and/or web address):
*

Is your organization a: *

Returning Member

New Member

Required

Please certify the fee owed, based on the annual revenue of your distress and/or crisis line:
*

$517.32 (annual revenue of $5,000 - $299,000)

$828.63 (annual revenue of $300,000 - $749,000)

$1,171.83 (annual revenue of $750,000 plus)

Required

PAYMENT OPTIONS

(Please choose one of the options below.)

I have mailed a cheque payable to “ONTARIO ASSOCIATION OF DISTRESS CENTRES” in the amount selected above to the address below.

I will pay by direct deposit to Bank number 001; transit number 00242; account number 1073-761 in the amount selected above.

Required

If you have any questions or concerns, please email us at info@dcontario.org.

The Ontario Association of Distress Centres

PO Box 40115

RPO Waterloo Square

Waterloo, ON

N2J 4V1

Mission: To be an association that is the recognized leader in promotion, collaboration and building capacity within organizations that provide distress and crisis response.

Vision: To foster an environment of collaboration and networking while providing universal access to support for individuals in distress and crisis.

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