Easter Seals Access2 Logo

NEW (FIRST TIME) APPLICANTS

STEP 1

FILL OUT APPLICATION

Complete “Section B – Applicant Information” (ensuring to check off the “New Card” box). The form can be found below.

Complete “Section C – Health Care Professional Authorization”. This section is to be completed by an authorized healthcare professional. Please refer to Section C for a list of accepted health care professionals.

Complete “Section D – Administration Fee Payment”.

DOWNLOAD APPLICATION FORM

STEP 2

MAKE PAYMENT

Payment can be made online with a credit card or a Visa debit card.

OR

A cheque or money order can be mailed to our office.

Paying online is highly recommended – as you will receive your card much faster.

MEMBERSHIP PRICES (2 options)

$20 for a new 3-year card

OR

$30 for a new 5-year card.

Please note: When purchasing an Access 2 Card online, the purchaser’s information will be automatically input under the Access 2 cardholder’s information on the next page. If the purchaser and Access 2 cardholder are different, please manually delete and input the cardholder’s name on the next page.

PAY ONLINE

STEP 3

SUBMIT YOUR APPLICATION

There are three ways you can submit your application: by e-mail, fax, or mail.

Please submit sections B, C, and D.

SUBMIT APPLICATION ONLINE