Somerset West Community Health Centre

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Membership

Application Form


You may also download our application form in PDF format

Please take a moment to complete and return this form to the Somerset West Community Health Centre.


Name:
Address:
Postal Code:
Telephone:
Email Address:
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Verification:

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Somerset West Community Health Centre is a registered charitable organization #11888 1671 RR 0001. Please call Karen Larsen at at 613-238-8210 if you have any questions. Thank you for your continued interest and support in Somerset West Community Health Centre!