Hong Fook Mental Health Association website

Membership

Online Registration

Membership Form
New Application
Renewal Application (Annual Renewal on June 1st of the year) * Regular Fee: $10.00 * Student Fee: $5.00 * Silver (Life membership): $250.00 * Gold (Life membership): $1,000.00

Member Since
First Name
Last Name

Mailing Address
Street
Apt/Suite
City
Province
Postal Code

Telephones
Home
Workplace
Cell
Pager
Fax
E-mail

Job Information
Occupation
Workplace

Languajes
Languages spoken	Cambodian Korean Chinese-Cantonese Chinese-Mandarin Vietnamese English Others (specify)

Preferred Language when in contact with Hong Fook	Cambodian Korean Chinese-Cantonese Chinese-Mandarin Vietnamese English Others (specify)

Volunteer
Yes, I would like to be a volunteer with Hong Fook. (You will be contacted with more detail.) I am already a Hong Fook Volunteer. In the past year, I have been involved in the following activities/committees:

Date




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