MEMBERSHIP APPLICATION FORM
Barbados Council for the Disabled (BCD)
“Harambee House”, Historic Garrison, St. Michael BB14038 Barbados
Tel: (246) 427 8136 Fax: (246) 427 5210 Email: [email protected]
Website: www.barbadosdisabled.org.bb
PLEASE COMPLETE THIS APPLICATION FORM CLEARLY AND CONCISELY USING BLOCK CAPITALS.
TITLE: Mr. □ Mrs. □ Ms. □ Miss □ Other □ Please state:
FIRST NAME:
MIDDLE NAME:
SURNAME:
DATE OF BIRTH (Y/M/D):
Tel: (h)
(w)
(c)
BARBADOS ID#:
MARITAL STATUS: SINGLE □ MARRIED □ DIVORCED □
WIDOW(ER) □
ADDRESS:
MAILING ADDRESS (if different from above):
CURRENT/FORMER OCCUPATION:
EMAIL ADDRESS:
DISABILITY TYPE:
AFFILIATED ORGANISATION:
CAREGIVER/GUARDIAN/ALTERNATE:
FIRST NAME
MIDDLE INITIAL
SURNAME
RELATION:
Tel: (h)
(w)
(c)
MEMBERSHIP FEES
Members of BCD Organisations: Biennial Fee: $15 □ Non-Members: Biennial Fee: $25 □
Payment method (please tick): Cash □
Cheque □
Are you willing to offer your services as a BCD volunteer with any our other Affiliates? If yes, in what areas?
Please see a listing of our Affiliate at the Back of the form
Please indicate your skills, interests and areas of expertise to update our skills bank.
Administration Duties □ Event Planning □ Shopping □ Reading □ Transportation □
Training □ please specify:
Signature:
Sum received: Cash □ Cheque □
Date (Y/M/D):
OFFICIAL USE ONLY
Date received (Year/Month/Day):
Receipt No.:
Membership expiry date (Y/M/D):
Signature:
BARBADOS COUNCIL FOR THE DISABLED AFFILIATES
Barbados Association for the Blind & Deaf
President
Mr. Elviston Maloney
426-3438 Workshop: 427-7453 (w)
Fax 228-0295
E-mail: [email protected]
Special Olympics Barbados
Chairman
Mrs. Donna King-Brathwaite
426-9064 Fax 435-2417
E-mail: [email protected]
The Autism Association of Barbados
President
Mr. Lawton Walcott
424-0455/Cell 822-2193
E-mail : [email protected]
Barbados Organization of Parents of the Disabled
(OPOD)
President
Mrs. Patricia Padmore-Blackman
437-5456
E-mail: [email protected]
M. S. Society of Barbados Inc.
President
Ms. Lasonta Corbin
571-1601/425-5902
E-mail: [email protected]
The Barbados Association Supported
Employment (First BASE)
Chairman
Ms. Dawn Rudder
Tel. 432-7075
Barbados National Organisation of the Disabled
BARNOD Inc.
President
Mr. Colbert Ashby
248-0656 (cell)
Website: www.barnod.org
E-mail: [email protected]
Association Aid for the Physically
Handicapped Children of Barbados
President
Mr. Fitzgerald Brereton
429-0158
Sunshine Early Intervention Trust
Director of Family Services
Mrs. Julie Sealy B/Sc.; MA; PhD
435-2604/[email protected]
Albert Cecil Graham Development Centre
Coordinator
Mrs. Yvette Cumberbatch
427-9514 or 436-9027 (F) 427-7448
Christian Learning Clinic
Director
Mrs. Loretta Lashley
424-9366/
[email protected]
E-mail: [email protected]
Paralympics Association of Barbados
Secretary
Mrs. Maureen Worrell
426-0049/232-7185/622-1601 Ext 1609
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E-mail: [email protected]
National United Society of the Blind
President
Mr. Rudyard Welch
234-3331
E-mail: [email protected]
Barbados Cheshire Homes Association/
Thelma Vaughan Home
President/Matron
Mr. Alyson Forte/Ms. Janice Smitten
467-4426(3)/ 429-0370
Barbados Association for Children with
Intellectual Challenges/Challenor Creative Arts
& Training Centre
President/CEO
Dr. Jennifer Campbell/ Ms. Sharrone Taitt
Tel. (w) 427-3541/427-3540
E-mail: [email protected]/
Tel. 438-6967 / 438-6862 FAX 438-7556
E-mail: [email protected]
Deaf Barbados Inc. (New Life Deaf Club)
President
Lionel Jason Smith
431-9604/267-7293
[email protected]
Barbados Association for the Correction
of Learning Disabilities/The Learning Centre
President/Principal
Mr. Joseph Tudor/Ms. Dawn Rudder
(t) 432-9676 Fax 432-9452/467-2465(W)
Cell 234-3147/E-mail: [email protected]
Myasthenia Gravis Association of Barbados
President
Mrs. Rosalind Mascoll
423-0683
E-mail:[email protected]