Paralympic Sports Association providing recreation and sport opportunities for children, youth and adults with a physical disability

Paralympic Sports Association

Membership Form

We appreciate your interest in becoming a member of PSA. Please fill out the following form and press submit. It will be e-mailed directly to us. If your browser does not support interactive forms, print off the form and fax it to us at (780) 432-0486 or mail it to us at Paralympic Sports Association, 10024-79 Avenue, Edmonton, Alberta, T6E 1R5.

Name:
Address:
City: Province/State:
Country:
Postal Code/Zip Code:
E-mail Address:
Phone: Home Work
Age:
under 18 years 18-25 years
26-40 years 41-55 years over 55 years

Male Female
Sport Affiliations:
Please check group(s) that you are associated with:

Wheelchair Sports Alberta
Alberta Cerebral Palsy Sports Association
Alberta Amputee Sports and Recreation Association
Alberta Association for Disabled Skiing
Alberta Sports and Recreation Association for the Blind
Alberta Northern Lights Wheelchair Basketball Society
Northern Alberta Disabled Divers Society
Northern Alberta Crippled Children's Fund
Little Bits Riding Club
Other (Please Specify)

Do you have a disability? Yes No

If yes, please specify the nature of your disability:

(Back to Top of Page)

Membership Category Individual/Single Membership $10 (full benefits)
Family Membership $20 (full benefits)
Associate Membership $10 (information only for interested associations, agencies, etc.)
Club Development
Please check one or more:

Fundraising
Ticket Sales
Casino
Bingos

Sports
Coach
Equipment
Committee

Public Relations
Photography
Demonstrations
Speaking

Recreation
Organizing/Planning
Work at Special Events
Committee

Areas of Interest
Bowling Teen Group Soccer Canasta Floor Hockey Swimming
Camp Unity Square Dancing Sledge Hockey Bowling Fun for Kids Socials/Dances

Other, please specify:

Would you like to have a workshop done in one of these interest areas? If yes, which one(s):
1.
2.
We appreciate your interest in joining the Paralympic Sports Association. Do you have any additional comments or information to add?
Comments:

If you have any questions, please contact PSA at (780) 439-8687 or e-mail us at [email protected]

[Top] [Back to the Introduction]

Name:
Address:
City:	Province/State:
Country:
Postal Code/Zip Code:
E-mail Address:
Phone:	Home Work
Age:	under 18 years 18-25 years 26-40 years 41-55 years over 55 years
	Male Female
Sport Affiliations:	Please check group(s) that you are associated with: Wheelchair Sports Alberta Alberta Cerebral Palsy Sports Association Alberta Amputee Sports and Recreation Association Alberta Association for Disabled Skiing Alberta Sports and Recreation Association for the Blind Alberta Northern Lights Wheelchair Basketball Society Northern Alberta Disabled Divers Society Northern Alberta Crippled Children's Fund Little Bits Riding Club Other (Please Specify)
Do you have a disability?	Yes No
	If yes, please specify the nature of your disability: (Back to Top of Page)
Membership Category	Individual/Single Membership $10 (full benefits) Family Membership $20 (full benefits) Associate Membership $10 (information only for interested associations, agencies, etc.)
Club Development	Please check one or more: Fundraising Ticket Sales Casino Bingos Sports Coach Equipment Committee Public Relations Photography Demonstrations Speaking Recreation Organizing/Planning Work at Special Events Committee
Areas of Interest	Bowling Teen Group Soccer Canasta Floor Hockey Swimming Camp Unity Square Dancing Sledge Hockey Bowling Fun for Kids Socials/Dances Other, please specify:
	Would you like to have a workshop done in one of these interest areas? If yes, which one(s):
1.
2.
	We appreciate your interest in joining the Paralympic Sports Association. Do you have any additional comments or information to add?
Comments: