Registration

Primary Member's First Name

Primary Member's Last Name

Primary Member's Year Of Birth

Address (You Apartment Number and Street Address)

Primary Member's Email

Primary Member's Mobile Phone Number (No dashes, only spaces e.g 604 944 8888)

City
—Please choose an option—VancouverBurnabySurreyRichmondNew WestCoquitlamPort CoquitlamAbbotsfordDeltaPort MoodyMaple RidgePitt MeadowsWhite RockLangleyTsawassenSquamishWhistlerKitsilanoOther

Number of Applicants For Lifetime Membership @$150 Per Member

Spouse's First Name

Spouse's Last Name

Spouse's Year Of Birth

Spouse's Email

Spouse's Mobile Phone Number (No dashes, only spaces allowed)

Family Doctor's Name

Doctor's Phone Number

Name of Next of Kin

Next of Kin Phone Number (No dashes, only spaces allowed)

Next of Kin Email Address

Next of Kin Relationship
SonDaughterMotherFatherBrotherSisterUncleAuntCousin

Address of Next of Kin

By Submitting this for , I/We agree to abide by the Terms & Conditions of GHSS and Accept its Privacy Policy

Members Waiver & Release Agreement