Membership

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Brock Community Health Centre (Brock CHC) looks to the community for support, input and leadership. We invite community-minded individuals to join our membership. As a member:

• You understand and support the work of Brock CHC, mission, vision and value statements, and our model of health and wellbeing, which guide the work we do.
• You stay updated on Brock CHC news and events and receive the Annual Report.
• You can attend and vote at any Members’ meetings
• You can participate in feedback opportunities
• You can help promote a healthy community and consider being nominated to the Board of Directors or getting involved with Board committees.

If you are interested in being a member of Brock CHC, or renewing your existing membership, please complete the application below. Members must be 18 years of age or older and reside or work in Brock Township, or receive care from Brock Community Health Centre.

Membership Application

Brock Community Health Centre (Brock CHC) looks to the community for support, input and leadership. We invite community-minded individuals to join our membership. As a member, you can:

• help shape the health of Brock and contribute to the well-being of your community
• stay updated on Brock CHC news and events and receive the Annual Report
• attend and vote at any Members’ meetings
• participate in feedback opportunities
• consider joining a Board committee or being nominated to the Board of Directors

Membership Type(Required)

New member

Renewing member

Membership is free and renewable every two years on the first of June. Brock CHC will send out a notice of expiry 30 days before this date. All membership applications must be approved by the Brock CHC Board of Directors and only thereafter will membership become active.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code

Phone(Required)

Email(Required)

Consent and Agreements(Required)

I am 18 years of age or older and reside, work or volunteer in Brock Township and surrounding areas or receive care from Brock CHC.

I support the organization’s mission, vision and value statements.

I understand and support the work of Brock CHC and the guiding model of health and wellbeing.

I certify that the information submitted on this application is true and correct to the best of my knowledge.

Please ensure you have read the linked pages on the second and third questions above.

Signature