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CanConnect-19 Membership Registration

Personal Details

Where Are You Located?

Your Age Range

Your Age Range
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Sex

Sex
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C

Emergency Contact Information

First Name

Last Name

Email

Phone Number

Do you believe you have been injured by the Covid-19 vaccines?

Do you believe you have been injured by the Covid-19 vaccines?
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B
C

Membership Requirements

I agree that abiding by the terms of membership is necessary to maintain membership, and failure to do so will result in removal from membership.
Membership Requirements
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B
Membership Requirements – CanConnect19 CanConnect19 offers two types of membership: Vaccine-Injured and Supporter Membership. 1. Vaccine-Injured Membership

This membership is for Canadians who have experienced adverse effects following a COVID-19 vaccination.

- Requires full completion of this intake form.
- Membership is $10/month (tax included).
- Members receive full access to our secure Circle community platform, including:
- Educational sessions
- Peer support groups
- Wellness partner directory
- Community resources, updates, and guest speakers.
Once registered, vaccine-injured members may choose to apply for , which involves a more detailed application process and makes them .
2. Supporter Membership
This membership is for allies, caregivers, healthcare professionals, and anyone wishing to learn, support, or stand in solidarity with the vaccine-injured community. - Membership is $20/month (tax included).
- Of this amount, $10/month is income tax deductible, with charitable receipts issued annually in January.
- The additional $10/month directly sponsors the membership of a vaccine-injured individual who may not be able to afford the cost themselves.
- Supporter members have full access to the CanConnect19 community platform, including:
- Events
- Educational content
- Resource library
- Public discussion spaces
*Supporter members do not qualify for bursary funding or specialized wellness support.
For any questions or to request a Full Membership application, please contact us at [email protected].
Please Note: All applications are subject to manual review by our team to ensure the safety, integrity, and alignment of our community. We appreciate your patience during this process. By applying for membership, you acknowledge and agree to the terms outlined above

How did you hear about CanConnect-19?