Associate Agency Membership

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Associate Agency Membership Application

Agency Name*

Website

Your Name*

Position*

Email Address*

Tel No.*

Mailing Address*

City*

Province*

Postal Code*

Please describe your reasons and interests in becoming a BCSTH Associate Agency Member.*

Please describe your interest in the Society’s purpose including its vision, mission, approach and guiding principles, and your commitment to providing services that address violence and abuse in the lives of all women, children and youth.*

Please describe your interest in the Society’s purpose including its vision, mission, approach and guiding principles and your commitment to providing services that address violence and abuse in the lives of all women, children and youth.*

BCSTH Bylaws require the following for your organization to be considered an Associate Agency Member. Please check if it applies to your agency.*

You are not in any conflict of interest with the Society. (The Society defines a conflict of interest as a situation in which an individual’s ability to exercise judgement or act in one role is, could be, or is seen to be impaired or otherwise influenced by their involvement in another role or relationship. A conflict of interest with the Society could be a direct or indirect financial interest, a non-financial or personal interest, or competing loyalties between the Society’s interests and a primary duty to another person or entity, or both.)

Associate Agency Membership Application

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