OWHC MEMBERSHIP APPLICATION FORM

The Ontario Healthy Workplace Coalition (OWHC) membership is open to all stakeholders associated with workplace health in Ontario and/or others with an interest in workplace health.

The following information is important as it provides the OWHC with a better understanding of the characteristics and interests of our membership. This helps us to serve you better. To join, please complete the following form.

Please check only one response to each item unless otherwise specified.

BUSINESS CONTACT INFORMATION - PRIMARY CONTACT
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1. I grant permission for my Business Contact Information (above) to be used for purposes such as email bulletins and membership information updates.*

Yes No
(Note: you will continue to receive renewal notices)

2. I am...*

A New Member A Renewing Member

3. I am...*

An Organizational Member An Individual Member A Student Member

* Organizational membership includes up to 5 individuals. Please provide the contact information for the remaining members.

Information: Member 1 Member 2 Member 3 Member 4 Member 5
First Name:
Last Name:
Title:
Business Telephone:
Business Email:
E-mail Consent: (Yes) (Yes) (Yes) (Yes) (Yes)

4. Type of Organization - Please check what best describes your organization.

  •  OH&S Council of Ontario & Associations
  •  Labour Organizations & Associations
  •  Workplace Health Service Providers
  •  Workplace Health Academia / Research
  •  Public Health Workplace Focused
  •  Workplace Focused Non-governmental
  •  Corporation/LLP/Private <1,000
  •  Corporation/LLP/Private >1,000
  •  Professional Organizations & Associations
  •  Government Workplace
  •  Education/Training
  •  Business Organizations & Associations
  •  Other, please specify:
  • Other:

5. How many employees are in your organization?

In Ontario:    
0-50 51-100 101-1000 1000+
Total # (if employees outside of Ontario):

4. Membership Category*

Organizational: $125 Individual: $60 Student: Complimentary
(Includes up to 5
organizational members)

Note: If there are special financial circumstances that prevent you from joining the Coalition, please let us know (contact@owhc.ca)

5. How did you find out about OWHC?

  •  Attended an OWHC Events
  •  From an Employer or co-worker
  •  Other, please specify:
  • Other:

* Required fields

Upon clicking the Submit Application button you will be taken to a "Notice to Reader Consent" form.
After completing this please mail the Consent form and your cheque to the OWHC

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