Register for a Membership Fill out this form to register for a membership. Only members can order food baskets. New Membership A membership term is from April 1st to March 31st. Choose a Membership * Individual - $ 5.00 Household - $ 5.00 Please renew my membership automatically. Membership will renew automatically. Transaction Fixed Fee * CA$0.26 Transaction Rate Fee Total Amount Billing details First Name * Last Name * Email Address * Phone * Billing Address Street Address * Apartment, suite, unit, etc (optional) Country * - select Country - Canada Province * - select State/Province - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory City * Postal Code * Pickup Location Pickup Location * - Select a Pickup Location - Alberta Avenue Community League (9210 118 Ave NW, Edmonton) Bardo Lutheran Church (4737 57 Avenue, Tofield) Barrhead and District FCSS (5115 45 St, Barrhead) Bethel Gospel Chapel (11461 95 Street, Edmonton) Beverly Daycare and Family Resource Centre (11005 34 Street, Edmonton) Dickinsfield Amity House (9213 - 146 Avenue NW, Edmonton) Edmonton Moravian Church (9540 83 Ave NW, Edmonton) Families First Society, Fort Saskatchewan (9901 90 Street, Fort Saskatchewan) Jasper Place Family Resource Centre (16811 88 Ave NW, Edmonton) Jasper Plaza Childcare Centre (10034 167 St NW, Edmonton) Leduc & District Food Bank (201 - 6051 47 St, Leduc) McCauley Apartments (9541 108a Ave, Edmonton) Millwoods Community Church (2304 38 St NW, Edmonton) Sir Douglas Bader Towers (11110 86 Ave NW, Edmonton) St. Albert United Church (20 Green Grove Drive, St. Albert) Strathcona County Family and Community Services (160 Festival Way, Sherwood Park) Westlock Gospel Chapel (10227 97 Street, Westlock) Household Information How many people live in your household? What is the makeup of your household? Preschooler Child(ren) in School Adult(s) Senior(s) Select if you have an allergy, health restriction or dietary commitment for health, religious or ethical reasons. This is used for future program development and event planning. No substitutions will be made based on your selections. Dietary Restrictions and Convictions celiac halal vegetarian vegan no processed no sodium no sugar no beef no red meat no fish no shellfish no animal milk no egg no tree nut no ground nut no peanut no wheat gluten no kiwi no sesame seed no banana no peach no soy bean no potato no pork Make this selection if you have limited mobility and may request support during a pickup, ie elevator lift, support with lifting, stairs, etc. Mobility Assistance Yes and I would like some support Communications Your Newsletter preferences * Digital via Email Paper with Food Basket Preferred Communication Method(s) PhoneEmailPostal Mail I have read and agree to the website terms and conditions and privacy policy. I agree to the website terms and conditions & privacy policy * Yes, I agree I have read and agree to the website terms and conditions and privacy policy. Payment Options Payment Method Credit Card Debit Card Credit Card Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 My billing address is the same as above Billing Name and Address First Name * * Billing Middle Name Last Name * * Street Address * City * Country * - select - Canada State/Province * - select State/Province - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Postal Code * Review your contribution