Membership Form Membership FormAre you? *New MemberRenewing MemberMembership Category *Athlete - $15Supporting Member - $5Sight Class BlindSight ImpairedSightedCNIB Registration Number If you are a coach, NCCP # Last Name *First Name *Street Address City/Town *Province *AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonPostal Code *Telephone (Day) (Format: xxx-xxx-xxxx) *Telephone (Evening) Email *Age Category *0-45-1213-1718-5455+Gender MaleFemaleOtherMedia Release *I authorize BC Blind Sports & Recreation Association to take and use photographs and/or video footage of my person and to use my name in website and other publications.I consentEmergency Contact InformationName *Relationship *Phone (Day) (Format: xxx-xxx-xxxx) *Phone (Evening) SportsSports of Interest AthleticsActive Living Network for AdultsCurlingFitness - VirtualDragon BoatDragon Boat Dryland -VirtualGoalballYoga - Chair - VirtualGolfHockeyJudoLawn BowlsPowerliftingShowdownSwimmingTandem CyclingTennisWrestlingOtherOther Sports Payment Method *Credit CardeTransferChequeCommunicationPreferred Communication Format EmailPrintNotes Membership in BC Blind Sports and Recreation Association includes membership in the Canadian Blind Sports Association. VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
