Membership Application

Download Membership Application Form

Membership Application

Principal Applicant

Applicant Form

Status in Canada

ABSAA ID (enter your phone number)

First Name

Last Name

Date of Birth

Gender

Address

City

Province

Postal code

Home Phone

Cell Number

Emergency Contact Person Name - 01

Emergency Contact Person Name - 02

Relation 01

Relation 02

TEL/CELL 01

TEL/CELL 02

Registration fee

$50.00

Principal fee

$50.00

Spouse fee

Dependents Fee

Yes

Numbers of dependents

Upload Principal Memeber Picture Id

Choose File

Spouse Details

Spouse First Name

Spouse Last Name

Date of Birth

Gender

Home Phone

Cell Number

Upload Spouse picture Id

Choose File

Dependents

Dependent First Name

Dependent Last Name

Relation

Date of Birth

Gender

Upload dependent picture Id

Choose File

Dependent First Name

Dependent Last Name

Relation

Date of Birth

Gender

Upload dependent picture Id

Choose File

Dependent First Name

Dependent Last Name

Relation

Date of Birth

Gender

Upload dependent picture Id

Choose File

Dependent First Name

Dependent Last Name

Relation

Date of Birth

Gender

Upload dependent picture Id

Choose File

Dependent First Name

Dependent Last Name

Relation

Date of Birth

Gender

Upload dependent picture Id

Choose File

Pre-Authorized Payment Plan

I, the Principal Applicant, do hereby authorize Al-Widaa Burial Support Association of Alberta (ABSAA) to withdraw the reimbursement share amount from my designated account to cover funeral costs of any deceased member of the organization, as and when required, up to a maximum of $15.00 per member. I further authorize ABSAA to withdraw if any registration fees, outstanding dues, and applicable penalties from my designated bank account.

Future Payment Options: (Please select and fill the info of only one option)

1. Automatic Withdrawal

Name of the Bank

Financial institution #

Transit #

Account Number #

Name of Account Holder

Effective Date

2. Credit Withdrawal

Credit Card holder Name

Exp.DATE

Credit Card Number

CVV

Payment Details

No payment items has been selected yet

Send Your e-Transfer Payment To:

absaaedmonton@gmail.com

E-Transfer Sent

Yes

I, the Principal Applicant by clicking the submit button below, hereby acknowledge and confirm that I have carefully read, fully understood and agreed with the terms and conditions and policies of ABSAA (AL-WIDAA BURIAL SUPPORT ASSOCIATION OF ALBERTA )