Applicant/Guardian(s)*:

Organization Name:

Telephone*:

Address*:

City*:

Province*:

Postal Code*:

Country:

Your Email*: (required)

First Child with autism diagnosis:

Child's Birth Date (YYYY-MM-DD):

Second Child with autism diagnosis:

Child's Birth Date (YYYY-MM-DD):

Third Child with autism diagnosis:

Child's Birth Date (YYYY-MM-DD):

You may enter other sibling's names and ages if you wish:

Please indicate if this is a Family, Professional or Supporter Membership*:

Attach proof of autism diagnosis here:
(Examples.. a physician signed document stating diagnosis and birthday, copy of original assessment or an email copy of summary of funding indicating age obtained by calling Autism Funding Unit(AFU).

Once you submit the membership form,
You can click below to pay online.

Membership Type

You do not need a Paypal account to pay online.
If you would prefer you can mail a cheque to:
Victoria Society for Children with Autism
#306-620 View Street
Victoria, BC V8W 1J6

Membership will be considered active when payment is received.

Membership renewals are due January 1st 2017.

New members who register in November or December are considered paid for 2017 and can begin to access programs from the date of registration.

Please fill out the required information.

You may register as a Family, Professional or Supporter.

 Professionals and Supporters benefit by:

* Keeping up with the latest Victoria area autism programs, activities and workshops through our newsletters.

* Gaining access to our lending library of books, videos and software on all aspects of autism.

* Supporting a great cause!

 Families can enjoy all of the above plus:

* Monthly meetings where you can meet other parents of children with autism.

* Access to respite funding or recreation program funding, as available.  Must provide proof of diagnosis and birthdate for each eligible child that is in your care.

* Access to free monthly social events for you and your children.

* Access to our equipment lending library.

 If you would prefer to print and mail in the membership form you may do so HERE.