Central East Local Health Integration Network

Application for General Membership in Lakeridge Health Corporation

Connect with Your Community Hospital. Become a Member of Lakeridge Health

Great things happen every day at Lakeridge Health.

Our team of talented and dedicated staff, physicians and volunteers make a difference in the lives they touch every day. By becoming a member of Lakeridge Health (LH), you add your voice to the growing number of Durham Region residents showing support for their hospital and high quality patient-centered care for our growing and aging community.

Your $10 membership entitles you to vote at the Annual General Meeting of the LH Board of Trustees. You will also receive regular emails keeping you up-to-date and informed about programs, services, and special projects currently underway at Lakeridge Health.

Membership is quick and easy.

Complete the online form below (credit card payments only) or download a print version of our application form, complete it, sign it and mail it to: Lakeridge Health, Unit 1, 850 Champlain Ave. Oshawa, Ontario L1J 8R2. Attn: Angela Tasevski.

All application forms must be received by Feb. 28, 2012 to be eligible.

*Membership Information*
Prefix:
First Name:
Last Name:
Company: (optional)
Address:
City / Town:
Postal Code:
Telephone w/Area code:
Email Address:
Renewal (check if Yes):
Payment Information ($10.00 CAD will be charged to your credit card)
Card Number:
Expiry:	Month: Year:
CVN *:
I have read and accept the Membership Criteria and Terms of Use, and I hereby verify that my membership meets the stated Membership Criteria.

Your order may take a moment to complete. Please do not hit the submit button more than once. Thank you.

* The CVN (Card Verification Number) is the 3-digit number on the back of your card.

Note: You may subscribe up to 4 memberships per day with the same credit card number.

Membership Criteria:

Members must be 18 or older, and submit a completed application form no later than February 28, 2011.

Each application must be accompanied by an individual payment. (e.g. - One completed form, one $10.00 payment)

Annual membership is effective for one year, from April 1 to March 31

All memberships must be approved by a resolution of the Lakeridge Health Board of Trustees

In this process, in addition to the best interests of the hospital, the Board is obliged to consider the applicant's interest in furthering the Lakeridge Health's objects, vision, mission and core values.

Payment will be returned for any rejected applications. Acknowledgement of receipt of application is by email only.

I agree to abide by the Bylaws of the Lakeridge Health as they apply to my membership

Limitations:

All memberships must be approved by a resolution of the Lakeridge Health Board of Trustees. Payment for $10 Cdn. will be returned for any rejected applications.

Fee for approved memberships are non-refundable.

Delivery:

Members will receive a letter confirming their membership once approved by Lakeridge Health's Board of Trustees in May.

Contact Information:

For more information regarding membership, please contact...

Lesley Bovie
Communications Officer
Lakeridge Health
Tel: 905-576-8711 ext. 4476
Email: lbovie@lakeridgehealth.on.ca

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