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CCHC Membership Application - 2026-27

Name:

Mailing Address:

Telephone number:

Email address:

I support the mission, vision and values of CCHC

Yes

Please check all that apply:

I reside within 5 km of 420 Cooper Street, Centretown Community Health Centre
I work within 5 km of 420 Cooper Street, Centretown Community Health Centre
I am a student with CCHC
I am a registered volunteer with CCHC
I am an active client of one or more programs at CCHC

Note on membership dates:
Memberships accepted between June 1, 2025 and May 30, 2026 will expire on June 30, 2026.

Today's Date: