• FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education

Associate Member Application

FAIR Associate Membership

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

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  

Accident victims can join for FREE, just fill out the form and check the box that says you are the victim and send the form to us.

If you are not a victim and would like to receive our emails you can join and you can mail your $15 membership fee cheque to:

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

       
 
I would like to become an annual member of FAIR and will forward my $15.00 cheque made out to FAIR. Accident victims can join for FREE
  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:
*

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.

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