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Agency Name *

Your Name *

Your Phone *

Your Email Address *

Agency Mailing Address *

City *

Province *

Postal Code *

Please enter the number of staff in core member programs. If you do not have one of the following MPSSG-funded core member programs please enter 0.

Community-Based Victim Services (CBVS) *

Stopping The Violence Counselling (STVC) *

Stopping the Violence Outreach Services (STV ORS) *

Multicultural Outreach Services (MORS) *

Sexual Assault Services (SAS) *

Total Number of Core Member Program Staff:

0.00

EVA BC core membership fee structure:

Tier	Total number of staff in EVA BC core member programs	Annual membership dues
1	1-3	$150
2	4-9	$400
3	10 or more	$900

Please select the matching membership tier below to see your dues total:

Membership Tiers: *

Total Amount

0.00

You will receive email confirmation for your payment, but you may want to save or print this page for your records.

Anti-Violence Worker Support