application-dual
 

sponsors

Thank you for your interest in the Dual Membership Programme. Please complete the form below.

Name:
Company (optional):
Address:

Town/City:
Province:
Postcode:
Home Phone:Other Phone:
Email:

Dual membership includes membership to both OBIA and one other association. Please Choose:
BIA of Chatham KentBIA of Sudbury and District
BIA of Grey BruceFour Counties Brain Injury Association
BIA of Peel HaltonBrain Injury Society of Toronto
BIA of Quinte DistrictSeizure & Brain Injury Centre Timmins
BIA of Sarnia-LambtonBIA of London and Region
BIA of Sault Ste Marie and DistrictBIA of South East Ontario
BIA of North Bay and AreaBIA of Niagara
BIA of Waterloo WellingtonBIA of Ottawa Valley
BIA of Windsor Essex CountyBIA of Thunder Bay and Area
HIA Fort Erie

Annual membership fees
Individual $30 Family $50 Subsidized $5