ASPECT Membership Application Form

If you have any questions please contact Nicki Reich at Tel: (250) 382-9675 ext 229 Toll Free: 1 888 287 4957 Fax: (250) 382-9677 Email: nreich@aspect.bc.ca.

1. Name of organization: *

2. Name(s) of Training or Employment Program(s) offered (if different from above):

3. Are these programs a part of a multi service organization?: *

Yes

4. If yes, what other types of services are offered?:

5. Contact person for ASPECT business:

Name: *

Position:

6. Executive Director (if different than above):

7. Site Address(es): *

8a. Telephone: *

8b. Fax:

9a. Email: *

9b. Website:

10. Mailing Address (if different from above):

11. Year Established:

12. Number of employees:

Demographics

ASPECT is frequently asked for the following demographics of our members. In order for us to represent you as accurately as possible, please answer the following questions:

12. Target Group of Program(s):

13. Nature of Funding

Please list all federal departments you contract with:

Please list all provincial ministries you contract with:

Please list other funders you contract with:

14. Employment Program Description(s):

(highlights and particulars, including program length and main training components). Please add extra pages as required.

Are you applying for a: *

Membership

Associate

Satellite Membership

SATELLITE MEMBERSHIPS are a new option for agencies with multiple offices, increasing contacts and services to staff of those offices. However each organization will only receive one voting privilege. Satellite membership is $100 per location.

Satellite Membership Location:

15. What is your reason for joining ASPECT?:

16. Please provide 3 references that can confirm the information you have provided: *

17. Other information you wish to add:

Agreement

I agree to: adhere to the ASPECT Professional Code of Ethics, and support the principles of Community Based Training, and

I give permission for ASPECT to include my contact information, target group and program description(s) in the ASPECT Membership Directory.

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ASPECT Membership Application Form