Plan to Protect® Membership Renewal Form

• • Today's Date*
    MM

    DD

    YYYY
  • Your Name*
    First Name

    Last Name
  • Organization Name*
    Name of the organization applying for membership.
  • Current Type of Membership*
    Membership category and cost is based on the average number of attendees /adherents your organization services (children, youth, & adults all included).
    >Choose a MembershipImplementation MembershipBasic MembershipDenomination/Association Head OfficeGoing the Distance Membership
  • Type of Membership Renewing at if different from current.
    >Implementation MembershipBasic MembershipDenomination/Association Head OfficeGoing the Distance Membership
  • Preferred Language*
    >EnglishFrenchBilingual
  • Address of Organization*
    Please fill in your organization's mailing address.
    Street Address*

    Address Line 2

    City*

    Province / State / Region*

    Postal Code / Zip

    Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

    Country*
  • Organization's Website
     
  • Is your organization part of an association, denomination or an affiliate of a larger organization*
    Yes

    No
  • If yes - name of denomination or affiliation*
  • Size of your organization/church/school including all attendees/adherents (children, youth and all adults).*
  • Annual Revenue of your organization.*
    What is the most recent annual revenue reported on your organization's taxes.
  • Name of Executive Director/Senior Pastor/Principal*
  • Organization Phone Number*
     
  • Primary Contact Person*
    Who will be the main contact between your organization and Plan to Protect®
  • Job Title / Role*
  • Email of Primary Contact
     
  • Phone Number of Primary Contact*
     
  • Secondary Contact Person*
    Who is another person at your organization that can be copied on communication between Plan to Protect® and your organization.
  • Job Title / Role*
  • Email of Secondary Contact
     
  • Phone Number of Secondary Contact*
     
  • Change in Contacts*
    Please list any staff that have left your organization in the last year so that we can be sure to update our files.
  • Would you like to add any of the following services to your invoice? Member discounts will be reflected on your invoice.*
    Policy Review and Gap Analysis Report (SRP $750)

    Bundle of Training

    Customized policies, procedure and forms (request a quote)

    Policy Update (request a quote)

    Administrator Leader Certification Training (SRP $449)

    Train the Trainer Certification Training (SRP $449)

    Crisis Response and Management Certification Training (SRP $449)

    Criminal Record Checks $29 per person

    LIVE Private Orientation Training (onsite or webinar format) (SRP $650)

    LIVE Private Refresher Training (onsite or webinar format) (SRP $550)

    Consulting (based on per diem consulting rates)

    No additional services
  • If purchasing a bundle of online training, what sized of bundle of online raining would you like to purchase (10, 25, 50, 75, 100, 250 or more)
  • If you would like to purchase additional copies of the Plan to Protect® manual, how many would you like to purchase at your discounted rate?
    >I do not wish to purchase a manual at this time12345
  • How can Plan to Protect® best assist you in the upcoming year?
  • How has being a Plan to Protect® member helped you in your organization's pursuit of meeting the STANDARD of abuse prevention and detection?
  • May we use your above response for promotional purposes?*
    Yes

    No
• Consent

  With Canada's anti-spam legislation we are required to obtain your consent to send you electronic communications. We do need express permission from each individual within an organization that we are communicating with.
  
  You may unsubscribe or withdraw your consent at any time by contacting us at Plan to Protect® 117 Ringwood Dr., Unit 11, Stouffville, ON L4A 8C1, or emailing us at info@plantoprotect.com.
  • Please confirm your consent to receive electronic communications from Plan to Protect® as described above. This consent will be considered as consent of the Primary Contact.*
    Yes I give my consent for all e-communications

    Yes I give my consent for Monthly e-Newsletters only

    No I do not give my consent
• 
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