CATIE Individual Membership Form

Membership is free and is perpetual.

 

CATIE membership lists are completely confidential. They are not provided, traded, rented or sold to any organization. We use an external distribution house for all printed materials. The mailing house destroys the lists after each mailing.


* Required field

Your Contact Information


First Name*

Last Name*

Organization Affiliation (if applicable)

To protect your privacy, DO NOT enter an organization name if you are using your home address. Mailing labels will be printed with all the address information you enter below.

Address Type*

Address 1*

Address 2

Address 3

City*

Province/Territory*

Postal Code*

E-mail*

If you provide your e-mail address we will use it to send you member communications.

Phone*

Extension

Fax

Gender (Choose what best applies to you.)

Date of Birth

 /   ( DD / MM )

This information is used only to distinguish between multiple members with the same name and prevent duplicate membership records.

Language of Correspondence*

Free Subscription Services

You can also subscribe to these publications without becoming a CATIE member at: http://www.catie.ca/en/about/media/subscriptions.

The subscription selections you submit in this form will override all previous selections. Please ensure to complete your subscription selections below to continue receiving your choice of free publications.

E-mail Services – fast, environmentally friendly and free

Please sign me up for the following e-mail services.

Free print subscription to The Positive Side magazine

All materials are mailed in plain brown envelopes.

The Positive Side, our health and wellness magazine written by and for people living with HIV, is also available as a free print subscription to Canadian residents only.

About You

We are collecting this information to better understand the diversity within our membership, for statistical purposes, and to help us send you the most relevant information and resources. All information will be kept confidential. Please tell us as much about yourself as you are comfortable sharing.

Area of Interest

(Program Development cannot be selected alone)


I Am
(Check all that apply)
 

I provide services for:
(Check all that apply)
 

Please tell me about resources that are:
(Check all that apply)





















CATIE strives to use terminology that reflects the way stakeholder groups would like to be described. We welcome your feedback regarding the terminology used in this form. Please contact us with your suggestions at: info@catie.ca.


By submitting this membership application I confirm that I want to be a member of CATIE and that I support the organization's knowledge exchange work

Donations

Should you wish to make a donation in support of CATIE's work, there are several secure and convenient options.

If you have any questions about your CATIE Membership, please telephone: 1-800-263-1638 extension 259 or e-mail at: info@catie.ca


Personal Information included in CATIE’s membership lists is completely confidential. It is not traded, rented, shared or sold to any organization or individual. Personal information will be made available only to authorized employees, contractors or agents of CATIE who need to access the information to provide the requested service.


Your personal information will only be used for the purpose for which you gave it to us unless we are required to do otherwise by law.


If you wish to update your contact details (for example, your mailing address), please contact us by e-mail at info@catie.ca or by telephone at (416) 203-7122 or 1-800-263-1638.