Membership Application

If you would like to become a member of OHSNA, please fill out the following form, and follow the instructions below to send your payment via cheque or e-Transfer. If you have any questions regarding memberships or would prefer us to send you an invoice by snail mail or email, please do not hesitate to contact us at the office number, or by email at [email protected].

FIRST NAME *

LAST NAME *

EMAIL ADDRESS *

PHONE & FAX *

HOME NAME *

HOME TYPE *

NUMBER OF BEDS

FOR FIRST HOME *

FOR SECOND HOME

FOR THIRD HOME

HOME ADDRESS (& PREF MAILING IF DIFFERENT) *

HOME CONTACT(S) & OWNER(S) *

OTHER HOME(S) OWNED (IF ANY)

MEMBERSHIP FEE: OHSNA annual membership fee consists of two charges; A Flat membership fee of $300.00 (only charged to one home if multiple ownerships), and a $15.00 per bed fee. Please use the following calculation to determine your home’s membership fee:

Calculate:

$300.00 + ($15.00 x beds) = $

TOTAL:

Payment Instructions

Please make all cheques payable to:

Ontario Homes For Special Needs Association
(IN FULL, PLEASE NO OHSNA)

SEND CHEQUE TO:

2729 Doane Road, Queensville, Ontario L0G 1R0

PAYMENT BY E-TRANSFER:

Alternately, payments can be made by Interac e-Transfer to [email protected].

Membership Application

NUMBER OF BEDS

$300.00 + ($15.00 x beds) = $

Payment Instructions

Please make all cheques payable to:

Ontario Homes For Special Needs Association
(IN FULL, PLEASE NO OHSNA)

SEND CHEQUE TO:

2729 Doane Road, Queensville, Ontario L0G 1R0

PAYMENT BY E-TRANSFER:

OHSNA

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Membership Application

NUMBER OF BEDS

$300.00 + ($15.00 x beds) = $

Payment Instructions

Please make all cheques payable to:

Ontario Homes For Special Needs Association(IN FULL, PLEASE NO OHSNA)

SEND CHEQUE TO:

2729 Doane Road, Queensville, Ontario L0G 1R0

PAYMENT BY E-TRANSFER:

Ontario Homes For Special Needs Association
(IN FULL, PLEASE NO OHSNA)