Membership Form

First Name*
Last Name*
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Newsletter Subscriptions
	Include me on other marketing material and promotions.
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I am an
	Athlete
	Volunteer
	Coach
	Parent or Caregiver
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I am over 16 years of age
	Yes
	No
My $10 membership fee will be paid by:
	Cheque mailed to Special Olympics Alberta, 11759 Groat Rd. Edmonton T5M 3K6
	Credit card payment made by phone 780-415-0719 or 1-800-444-2883
	I am a Special Olympics athlete! Membership is free. (must be registered in at least one sport).