Clone of Membership Form 2025

Membership Form:

Membership fees are $20.00 per year and are valid from February 1st to January 31
The Spina Bifida and Hydrocephalus Association of Northern Alberta (SBHANA) provides members and their families with a wide range of resources that assist with managing spina bifida and/or hydrocephalus.

A member in good standing with the SBHANA will have access to the Support Fund, Holiday/Christmas Party, NoLimits Peer Support Group, Moms Support Group and Retreat, Camps, voting at the AGM, Walk & Roll BBQ, Sport Try-It Days, Mental Health Program, and our Monthly E-Newsletter.

For more information about any of the services that SBHANA provides please contact the SBHANA office at info@sbhana.org or call 780-451-2921
Individual (for adults 18+)Parent / GuardianVolunteerSupporter or Organization
Name*

First NameLast Name
Name of person with SB/H (if different than above)

First NameLast Name
Date of birth of person with spina bifida and/or hydrocephalus

MonthDayYear
Date
Spina bifidaHydrocephalusN/AOther (please describe below)
Other:
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
FemaleMaleOther
YesNo
CasinoFundraisingMember SupportBoard of DirectorsWalk and Roll eventHoliday PartyKMS Smokie saleOther
YesNo
Is there a program you would like to see SBHANA offer?
1 Year Membership
Debit/Credit card - complete the section belowPaypal - complete the section belowE-transfer - send to: info@sbhana.org and submit your formPay by Cheque - mail to: SBHANA, #400, 11010 - 101 Street, Edmonton AB T6H 4B9Other
*Please ONLY select this box if you are making payment byDebit/Credit card, or Paypal
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2026 SBHANA Membership
$20.00CAD Quantity

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Your support helps us to continue our programs and services. We are grateful for your donation! Tax receipts will be issued for gifts over $20. *Please choose quantity to increase the donation amount in $10 increments.

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