Network Membership Form 2025

Welcome to the Edmonton and Area Fetal Alcohol Network (EFAN) membership form! By completing this form, you are joining a collaborative network committed to addressing Fetal Alcohol Spectrum Disorder (FASD) through advocacy, education, and community support. Your information will help us tailor our efforts to better serve our members and the community.

As part of this process, we ask that you review and certify your understanding of EFAN’s confidentiality policy, which ensures the protection of all members’ information and upholds the integrity of our network. For more details on our confidentiality policy and other guidelines, please refer to EFAN’s Operational Policies and Procedures (2024–2027), available here.

Thank you for your commitment to EFAN and for taking this important step to join our mission. We look forward to working together!

Member Information

Member Name *

First

Last

Email *

Agency

Program

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Authorizations

Confidentiality *

I certify that I have read the Edmonton and area Fetal Alcohol Network policy on confidentiality. I agree to abide by the requirements of the policy and inform the Society Co-Chairs if I believe any violation (unintentional or otherwise) of the policy has occurred. I understand that violation of this policy may lead to disciplinary action, up to and including termination of my membership with the Edmonton and area Fetal Alcohol Network Society.