Become a Member

Mission: Supporting individuals, families, and communities through the process of dying, death, and bereavement.

Personal Information

Name

First Name

Last Name

Date of Birth

Address

Phone Number

Background and Interests

What motivates you to become a member of our association? (Please describe briefly your interest in supporting people at the end of life or your connection to the cause.) 

Do you have any professional or personal experience in end-of-life care, palliative support, counselling, or related fields? 

Yes

If yes, please describe below

How would you like to be involved? (Check all that apply) 

Volunteering (e.g., companionship, respite support) 

Advocacy and Awareness

Fundraising and Events

Administrative or Governance Support

Providing Professional Expertise (e.g., medical, legal, grief counselling)

Other

For professionals, do you have your own professional indemnity insurance? If yes, please provide details:

Membership Commitment

By submitting this application, I acknowledge the values and mission of the Shifra Centre - Shifra Dying with Dignity Incorporated and agree to contribute to its goals with compassion, respect, and integrity. I understand that all members are expected to act in a manner that supports individuals and families during one of the most vulnerable times in life.  Indemnity: I agree to indemnify and hold harmless the Shifra Centre, its board, staff, and volunteers from any and all liability, claims, demands, and unauthorized expenses arising out of or in connection with my involvement in the association.  Confidentiality: I acknowledge that in the course of my involvement with the Shifra Centre, I may have access to sensitive personal or organizational information. I agree to keep such information confidential and to use it solely for purposes directly related to the activities of the association.

Date