MEMBERSHIP FORM

WE WOULD LOVE TO HAVE YOU AS A MEMBER

 

Please print and fill out the form below

and mail or email  to:

Psychiatric Survivors Network of Elgin
499 Talbot Street, St. Thomas Ontario, N5P 1C3

Email: psne@rogers.com


Goals and Objectives

To establish and operate an organization for the purpose of addressing the inequities of the mental health system identified by people who have been the subject of psychiatric treatment (mental health survivors) by:

a. Encouraging and empowering psychiatric survivors.
b. Encouraging and organizing educational activities.
c. Making presentations to government about mental health issues
d. Encouraging independent living
e. Encouraging self-advocacy, whenever this is possible
f.  Networking with other psychiatric survivor groups

Please indicate your membership preference with a check mark below:

___ A. General Member - A psychiatric survivor, who agrees with the Goals and Objectives of P.S.N.E. and has voting privileges.

___ B. Newsletter Member - Not a member of P.S.N.E. but receives the newsletter.

          __ By Mail         OR      __ Email: _____________________________________

          __ Read it online at www.psne.ca

Name: ____________________________ Phone:_________________________

Street: ____________________________ City/P.C.:_______________________


Comments or Suggestions: ________________________________________________

Date of Birth: ___________________________________________

 


If you would like to become a member you can also send the above information through email to us at

psne@rogers.com

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499 Talbot St, St. Thomas, Ontario N5P 1C3    Phone: 519-631-1580