Hospital Membership Form

ANNUAL MEMBERSHIP TYPES

Individual/Spousal
Applicant has been a resident of, owns property in, or has been employed or carried on business in the County of Dufferin; or the Town of Caledon in the Regional Municipality of Peel; or the Township of Adjala-Tosorontio in the County of Simcoe; or the Township of Southgate in the County of Grey; or the Town of Erin in the County of Wellington for at least (3) three months immediately prior to the date of this application.

Organization
Applicant has its head office in, or has its principal place of business in, or has owned property in the County of Dufferin; or the Town of Caledon in the Regional Municipality of Peel; or the Township of Adjala-Tosorontio in the County of Simcoe; or the Township of Southgate in the County of Grey; or the Town of Erin in the County of Wellington for at least three (3) months immediately prior thereto.
 
Donor
Individuals contributing $1,000 or greater annually to the Headwaters Health Care Foundation can be enrolled as Hospital members at no charge. All donor information is confidential. Please complete the membership form and submit to Jennifer Shephard in the Headwaters Health Care Foundation office for enrollment.
 
Click here to join or view the Hospital Membership Form.