Membership Sign-Up Form

Fields marked with "*" are required.

Agency Information

Please complete all sections. The address, general email address and website will be used to update member agencies on Abilities Manitoba’s website. Please note that your agency will be responsible to notify Abilities Manitoba of any changes to this information.

If you are experiencing difficulties completing your membership form, please contact admin@abilitiesmanitoba.org

Agency Name *
Address *
City / Town *
Postal Code *
General Email Address *
Phone Number *
Website



Executive Director/CEO

Name *
Email Address *



Board President (optional)

Name
Email Address



Finance/Accounts Receivable

Complete this if you want invoices forwarded to someone other than the Executive Director.

Name
Email Address

 



Do you provide support to populations other than adults with intellectual disabilities? *
YesNo

 

Please answer the below questions for services related only to adults with intellectual disabilities:

Number of Unionized Employees *
Number of Non-Unionized Employees *
Number of Direct Support Positions *
Union Involved
Year Organization Was Unionized
Total Number of Employees *

 

Types of services offered:

(and number of people per type of service) Enter 0 if not-applicable.

Number of volunteers who contribute to the work of your agency (include volunteer Board of Directors) *
Number of people you support who volunteer during hours you provide services to them *
Day Services *
Supported Employment*
Social Enterprise *
Supported Independent Living *
Residential Services *
Foster/Home Share *
Respite *
Crisis Support *
Other *

 

In which region(s) of Manitoba do you provide services? Please select all that apply by holding 'Ctrl' key and left clicking regions. *

 

Annual Operating Budget of Agency *
$

 

We receive CLDS funding *
YesNo

Annual Community Living Disability Services(CLDS) Funding From All Sources *
$
Your Fee: $

Note: Memberships are calculated based on 0.04% of your annual CLDS funding. The minimum membership fee is $150.00 and the maximum fee is $10,000. We will adjust invoices accordingly

Your Fee: $

Note: Memberships are calculated based on 0.04% of your annual operating budget. The minimum membership fee is $150.00 and the maximum fee is $10,000. We will adjust invoices accordingly

 

Associate Membership

Associate memberships are available for individuals working in services or related groups. This is a non-voting membership. The fee for Associate Memberships is $300.00.

I'm applying for an Associate Membership

 

Payment Schedule - please select a payment option *
One time payment (April)Two payments (April and October)Quarterly payments (April, July, October, January)

 

If you are interested in receiving a special consideration application for reduced membership fees please email admin@abilitiesmanitoba.org



Who would you like to receive Abilities Manitoba emails?

Name
Title
Email

 

Name
Title
Email

 

Name
Title
Email

 

Name
Title
Email

 



Member Certification (for agencies)
I certify that this organization:


 

Associate Certification
I certify that this organization:

 

Membership Fees
Final approval of this membership application will be based on receipt of the applicable membership fee. Payment can be made by cheque or PayPal. An invoice will be sent to your agency shortly.