Relief Membership application or renewal Form

This form includes a section for the payment of the annual fees. By completing and submitting this secure form with your payment information, you are consenting to the payment by credit card of the one-year $40 membership fee.

Contact information

First name

Last name

Phone number

Please help us improve and maintain our services by answering the following questions

Language

Specify if desired

The first 3 characters of your postal code

Year of birth

Gender identity

Please specify your gender identity

How did you hear about Relief?

Billing information

Address (Row 1)

Address (Row 2)

City

Province

Required field for residents of Canada and the United States

Postal Code

Country

Payment Information

Name on the card

Card number

CVV

Card type

VisaMastercard

By checking this box, I consent to the collection and processing of my personal information in accordance with Quebec's Law 25. I understand that this information will be used solely for the purpose of the provided service and will not be shared with third parties without my explicit consent.

Contact Information