APPENDIX 6 - MEMBERSHIP APPLICATION: BODY IMAGE COALITION OF PEEL

The Body Image Coalition of Peel is committed to raising awareness and understanding of body image issues and eating disorders by advocating for improved prevention strategies and treatment options. Membership is open to any individual or organization representative who shares this commitment.

Attendance at our three annual meetings provides networking and in-service opportunities. Members also have the unique opportunity to get involved in exciting Coalition projects and to help mould the future direction of the Coalition.

For more information, please contact:
(905) 701-7800 Ext. 2063 (Param Nirwan)
info@bodyimagecoalition.org (Moira Slater)

To become a member please print the form below and mail in this application:

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THE BODY IMAGE COALITION OF PEEL
MEMBERSHIP APPLICATION

I wish to join / renew my	Individual Membership - fee of $10 per year Corporate Membership - fee of $25 per year (allows multiple staff at the same organization to become Coalition members)
The membership year lasts from April 1st to March 31st. Please submit payment to: The Body Image Coalition of Peel 10 Peel Centre Dr., Suite B PO Box 2009, STN B Brampton ON L6T 0E5 Please complete for individual membership and for each individual joining under a corporate membership:
Name:	____________________________________________________
Title & Profession:	____________________________________________________
Organization:	____________________________________________________
Address:	____________________________________________________
City:	____________________	Province:	_____________________
Postal Code:	____________________________________________________
Phone:	____________________	Fax:	_____________________
Email:	____________________________________________________
Website:	____________________________________________________
I am interested in:
	Membership only Helping with a project Joining the Steering Committee

Please mail this form to the address above, with payment to:

The Body Image Coalition of Peel

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