Membership Application

Please enter the following information, then click the Submit Member Application Form button.

The Membership Fee is only $10 per year.

When you have completed the on-line Membership Application:

Go to Membership Payment to make your payment by PayPal or etransfer
OR
Send a cheque to:
Pacific Open Heart Association
PO Box 45001
Ocean Park PO
Surrey, BC
V4A 9L1

Membership Form

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

First Name*

Last Name*

Phone*

Email*

Address*

Surgery Hospital

Are you a new customer?

Interested in being a hospital visitor?

Interested in being a POHA volunteer?

Interested in our golf tournament?

Remarks

Your Support Makes a Difference

POHA donates to cardiac hospital wards each year to help purchase cardiac equipment and other patient resources. Your support helps us continue providing awareness, guidance, and community support for heart patients and families.