This page is optimized for desktop only. Please enter in the information below. It will form the basis for your online profile on BCACDI Agency listing page.

Organization Name

Organization Website

Name of Executive Director ("ED")

ED Phone Number

ED Email

If the Executive Director will not be the key contact for your organization for BCACDI related correspondence, please provide a name and contact information for your Alternate Representative ("AR"):*

AR Name

AR Email

Organization Mailing Address

Please provide an estimate of total dollar amount of government contracts (held for all services and programs for children and youth with special needs, or at risk of developing a developmental delay) from all ministries, NOT total budget.

Estimated Value of Government Contracts

Please accompany this membership application form with the following:

Agency Mission Statement and Vision
List of services provided (e.g. – IDP, SLP, Family Support, etc.)
List of your Society's current Board of Directors and Executive Committee

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IMPORTANT:

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If the form does not Submit, scroll up as a required field may have been missed.
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You will be contacted after your application has been reviewed by BCACDI Staff (approximately 2 weeks).

AR Phone

Applying For Membership

Full Membership

Associate Membership

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Member Application Form

MEMBER AGENCIES