Hemophilia Saskatchewan

Thank you for signing up as a member of Hemophilia Saskatchewan! Providing us with the following information will ensure that we can invite you to all events and programs through our organization. Newsletters are distributed four times per year, and invitations to special events are emailed out several times per year as well. Thank you for your continued support, and we look forward to connecting with you soon!

There is no fee to become a member.

* indicates required

First Name

Last Name

Email Address *

Phone Number

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Bleeding disorder diagnosis (if applicable)

Household size

Gender: To direct appropriate information to you.

Male
Female
Other
Prefer not to disclose

Membership Category:

Regular Member: People diagnosed with an inherited bleeding disorder, immediate family members and c
Associate Member: Individuals desiring to support the above stated mission of the Chapter
Heath Care Provider Member: Health care providers treating people with inherited bleeding disorders.
Honorary Member: Individuals who have made an outstanding achievement towards furthering the mission

Consent

I consent to providing my information to Hemophilia Saskatchewan and the Canadian Hemophilia Society