FAIR – supporting auto accident victims through advocacy and education

Associate Member Application

FAIR Associate Membership

‘FAIR – supporting auto accident victims through advocacy and education’

Car accident survivors deserve better than coverage that only works some of the time for some people!

Join FAIR as an Associate Member by filling out the form below or for a printable form you can Click here for Associate Membership Form

You can join on-line or mail your form to:

FAIR
579A Lakeshore Road E
P.O. Box 39522
Mississauga, ON L5G 4S6

ON-LINE: Please be sure that you receive an acknowledgement letter from the Administrator at FAIR. If you do not receive a letter it means that your form is missing information and you will have to resend.

Comments are closed.


	I would like to become a member of FAIR.
	Date	*
	First Name	*
	Last Name	*
	Address
	Suite/Unit
	City
	State/Province/Region
	Postal/Zip Code
	Country
	Email Address	*
	Age Category
	Are you the accident victim?	Yes No*
	If not the victim, are you a family member?	Yes No
	Please describe the date of your motor vehicle accident and the nature of your related injuries or impairment:

	Were your injuries deemed catastrophic	Yes No
	Did your accident occur in Ontario?	Yes No*
	Is this action being litigated in Ontario?	Yes No*
	Has your employment and/or health changed since your accident and how?

Please check the box below: *