Contact us
Membership Application:
CANADIAN MENTAL HEALTH
ASSOCIATION
LUNENBURG/QUEENS BRANCH
Office Location: 215 Dominion Street. Suite 108 Gateway Plaza Bridgewater, NS
(ACSBE Resource Centre)
Mailing Address: 450 LaHave St. Unit 17, Box 117
Bridgewater, NS, B4V 4A3
Phone: 902-521-1153 E-mail: cmha.lunenburg@gmail.com
Member’s Name:__________________________________________
Address: _____________________________________________________________________
Phone:______________________Work:_______________________Cell:_______________________
E-mail: _____________________________________________
Please tell us a bit about yourself:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________
Members Signature:__________________________________
Date: ________________
President’s signature:_______________________________________
Date: ________________________
_____________________________________________________________________________________
Office Use
Annual dues $12.00 Membership number: ___________________
New: Renewal:
Mail out: Receipt Membership card Welcome letter Objectives Date_______________
Dues received: $_______________ Received by:______________________
Date:____________
Received by Treasurer: __________________________________________ Date:___________
Receipt No: _______________________
Write:
Canadian Mental Health Association, Lunenburg/Queens Branch
450 LaHave St., Unit 17, Box 117
Bridgewater, NS B4V 4A3
Board President:
Denton Conrad
Phone:
(902) 541-1153
Email:
Visit our office:
Gateway Plaza (In The ACSBE Resource Centre)
215 Dominion Street, Suite 108
Bridgewater, Nova Scotia