Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastLayoutAddress *Date of Birth *Postal Code *Telephone *Email *Would you like to receive notices from BRISC via email? *YesNoPreferred method of contact *EmailPhoneCanada PostEthnicity *StatusNon-StatusMetisOther (Please Define)OtherMembership TypeFamily Membership – $5.00Adult Membership – $3.00Elder/Senior Membership – $2.00Honorary Membership – $0.00Friends of the Friendship Center – non-voting – $5.00LayoutList children under 18Date of BirthWould you be interested in Volunteering?YesNoIf yes, what skill or gift would you like to share?SignatureClear SignatureMEMBERSHIP RIGHTS AND ELIGIBILITY AS PER THE BYLAWS OF THE BRANTFORD REGION INDIGENOUS SUPPORT CENTREMembership is not valid until after approval at the board meeting until the next AGM Submit