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Associate Member Application
Please read the IMPACT Membership Application Primer before beginning your application:
Membership application primer 2020 11
General Contact Information for Member Entity:
Entity Legal Name:
Entity is also known as:
Street Address of Entity:
Mailing address of Entity (if different from street address):
City/Town:
Province:
Postal Code:
Website for Entity:
General Email Address for Entity:
Phone Number for Entity:
Intake Contact and Phone Number for Entity:
Designated Contact for Member Entity
Name of Designated Contact:
Preferred Name & Preferred Pronouns for Designated Contact:
Title of Designated Contact:
Phone Number for Designated Contact:
Email of Designated Contact:
Please describe your entity's main area(s) of focus:
Select all that apply
Addictions
Secondary Education
Funders
Women's Shelters
2SLGBTQ+
Faith
Sexual Abuse
Indigenous
Disabilities
Schools
Health
Treatment
Research
Immigrant/Ethno-cultural communities
Sexual Health
Sexual Exploitation
Domestic violence
Seniors
Homelessness
Other (please specify)
Please identify the community you
primarily
work in:
(1 selection only)
Province-wide
County of Newell (Brooks)
Kapawe'no First Nation
MD of Provost No. 52 (Provost)
Samson Cree Nation
Calgary
County of Northern Lights (Manning)
Kehewin Cree Nation
MD of Ranchland No. 66 (Nanton)
Sawridge Band
Edmonton
County of Paintearth No. 18 (Castor)
Kikino Metis Settlement
MD of Smoky River No. 130 (Falher)
Siksika Nation
Alexander First Nation
County of St. Paul No. 19 (Elk Point)
Kneehill County (Three Hills)
MD of Spirit River No. 133 (Spirit River)
Smith's Landing First Nation
Alexis Nakota Sioux Nation
County of Stettler No. 6 (Stettler)
Lac La Biche County
MD of Taber (Taber)
Smoky Lake County (Smoky lake)
Athabasca Chipewyan First Nation
County of Two Hills No. 21 (Two Hills)
Lac La Biche County (Avenir)
MD of Wainwright No. 61 (Wainwright)
Starland County (Delia)
Athabasca County (Athabasca)
County of Vermilion River (Lloydminster)
Lac Ste. Anne County (Mayerthorpe)
MD of Willow Creek No. 26 (Claresholm)
Stoney Tribe (Bearspaw, Chiniki and Wesley)
Beaver County (Ryley)
County of Warner No. 5 (Milk River)
Lacombe County (Lacombe)
Mikisew Cree First Nation
Strathcona County
Beaver First Nation
County of Wetaskiwin No. 10 (Wetaskiwin)
Lamont County(Bruderheim)
Montana First Nation
Sturgeon County (St. Albert)
Beaver Lake Cree Nation
Cypress County (Medicine Hat)
Leduc County (Leduc)
Mountain View County (Carstairs)
Sturgeon Lake Cree Nation
Big Lakes County (High Prairie)
Dene Tha' First Nation
Lethbridge County (Lethbridge)
Municipality of Crowsnest Pass
Sucker Creek First Nation
Bigstone Cree Nation
Driftpile First Nation
Little Red River Cree Nation
Municipality of Jasper
Sunchild First Nation
Birch Hills County (Belloy)
Duncan's First Nation
Loon River First Nation
Northern Sunrise County (Nampa)
Swan River First Nation
Blood Tribe
East Prairie Metis Settlement
Louis Bull Tribe
O'Chiese First Nation
Tallcree First Nation
Brazeau County (Drayton Valley)
Elk Island District
Lubicon Lake Band
Paddle Prairie Metis Settlements
Thorhild County (Alpen)
Buffalo Lake Metis Settlement
Elizabeth Metis Settlement
Mackenzie County
Parkland County (Spruce Grove)
Tsuu T'ina Nation
Camrose County (Camrose)
Enoch Cree Nation
MD of Acadia No. 34 (Haven)
Paul First Nation
Vulcan County (Vulcan)
Cardston County (Cardstone)
Ermineskin Cree Nation
MD of Bighorn No. 8 (Banff)
Peavine Metis Settlement
Waterton Disctrict
Chipewyan Prairie First Nation
Fishing Lake Metis Settlement
MD of Bonnyville No. 87 (Coldlake)
Peerless Trout First Nation
Westlock County (Westlock)
Clear Hills County (Bear Canyon)
Flagstaff County (Daysland)Kananaskis District
MD of Fairview No. 136 (Fairview)
Piikani Nation
Wheatland County (Strathmore)
Clearwater County (Rocky Mountain House)
Fort McKay First Nation
MD of Foothills No. 31 (High River, Okotoks)
Ponoka County (Rimbey)
Whitefish Lake First Nation (Atikameg)
Coldlake Area District
Fort McMurray First Nation
MD of Greenview No. 16 (Fox Creek)
Red Deer County (Red Deer)
Whitefish Lake First Nation (Goodfish)
Cold Lake First Nations
Frog Lake First Nation
MD of Lesser Slave River No. 124 (Slave Lake)
Regional Municipality of Wood Buffalo
Willmore Wilderness District
County of Barrhead No. 11 (Barrhead)
Gift Lake Metis Settlement
MD of Opportunity No. 17 (Calling River)
Rocky View County (Airdrie)
Woodlands County (Whitecourt)
County of Forty Mile No. 8 (Bow Island)
Heart Lake First Nation
MD of Peace No. 135 (Grimshaw)
Saddle Lake Cree Nation
Woodland Cree First Nation
County of Grande Prairie No. 1 (Grand Prairie)
Horse Lake First Nation
MD of Pincher Creek No. 9 (Pincher Creek)
Saddle Hills County (Bay Tree)
Yellowhead County (Edson)
County of Minburn No. 27 (Vegreville)
Please identify all other communities served by this entity:
(select all that apply)
Province-wide
County of Newell (Brooks)
Kapawe'no First Nation
MD of Provost No. 52 (Provost)
Samson Cree Nation
Calgary
County of Northern Lights (Manning)
Kehewin Cree Nation
MD of Ranchland No. 66 (Nanton)
Sawridge Band
Edmonton
County of Paintearth No. 18 (Castor)
Kikino Metis Settlement
MD of Smoky River No. 130 (Falher)
Siksika Nation
Alexander First Nation
County of St. Paul No. 19 (Elk Point)
Kneehill County (Three Hills)
MD of Spirit River No. 133 (Spirit River)
Smith's Landing First Nation
Alexis Nakota Sioux Nation
County of Stettler No. 6 (Stettler)
Lac La Biche County
MD of Taber (Taber)
Smoky Lake County (Smoky lake)
Athabasca Chipewyan First Nation
County of Two Hills No. 21 (Two Hills)
Lac La Biche County (Avenir)
MD of Wainwright No. 61 (Wainwright)
Starland County (Delia)
Athabasca County (Athabasca)
County of Vermilion River (Lloydminster)
Lac Ste. Anne County (Mayerthorpe)
MD of Willow Creek No. 26 (Claresholm)
Stoney Tribe (Bearspaw, Chiniki and Wesley)
Beaver County (Ryley)
County of Warner No. 5 (Milk River)
Lacombe County (Lacombe)
Mikisew Cree First Nation
Strathcona County
Beaver First Nation
County of Wetaskiwin No. 10 (Wetaskiwin)
Lamont County(Bruderheim)
Montana First Nation
Sturgeon County (St. Albert)
Beaver Lake Cree Nation
Cypress County (Medicine Hat)
Leduc County (Leduc)
Mountain View County (Carstairs)
Sturgeon Lake Cree Nation
Big Lakes County (High Prairie)
Dene Tha' First Nation
Lethbridge County (Lethbridge)
Municipality of Crowsnest Pass
Sucker Creek First Nation
Bigstone Cree Nation
Driftpile First Nation
Little Red River Cree Nation
Municipality of Jasper
Sunchild First Nation
Birch Hills County (Belloy)
Duncan's First Nation
Loon River First Nation
Northern Sunrise County (Nampa)
Swan River First Nation
Blood Tribe
East Prairie Metis Settlement
Louis Bull Tribe
O'Chiese First Nation
Tallcree First Nation
Brazeau County (Drayton Valley)
Elk Island District
Lubicon Lake Band
Paddle Prairie Metis Settlements
Thorhild County (Alpen)
Buffalo Lake Metis Settlement
Elizabeth Metis Settlement
Mackenzie County
Parkland County (Spruce Grove)
Tsuu T'ina Nation
Camrose County (Camrose)
Enoch Cree Nation
MD of Acadia No. 34 (Haven)
Paul First Nation
Vulcan County (Vulcan)
Cardston County (Cardstone)
Ermineskin Cree Nation
MD of Bighorn No. 8 (Banff)
Peavine Metis Settlement
Waterton Disctrict
Chipewyan Prairie First Nation
Fishing Lake Metis Settlement
MD of Bonnyville No. 87 (Coldlake)
Peerless Trout First Nation
Westlock County (Westlock)
Clear Hills County (Bear Canyon)
Flagstaff County (Daysland)Kananaskis District
MD of Fairview No. 136 (Fairview)
Piikani Nation
Wheatland County (Strathmore)
Clearwater County (Rocky Mountain House)
Fort McKay First Nation
MD of Foothills No. 31 (High River, Okotoks)
Ponoka County (Rimbey)
Whitefish Lake First Nation (Atikameg)
Coldlake Area District
Fort McMurray First Nation
MD of Greenview No. 16 (Fox Creek)
Red Deer County (Red Deer)
Whitefish Lake First Nation (Goodfish)
Cold Lake First Nations
Frog Lake First Nation
MD of Lesser Slave River No. 124 (Slave Lake)
Regional Municipality of Wood Buffalo
Willmore Wilderness District
County of Barrhead No. 11 (Barrhead)
Gift Lake Metis Settlement
MD of Opportunity No. 17 (Calling River)
Rocky View County (Airdrie)
Woodlands County (Whitecourt)
County of Forty Mile No. 8 (Bow Island)
Heart Lake First Nation
MD of Peace No. 135 (Grimshaw)
Saddle Lake Cree Nation
Woodland Cree First Nation
County of Grande Prairie No. 1 (Grand Prairie)
Horse Lake First Nation
MD of Pincher Creek No. 9 (Pincher Creek)
Saddle Hills County (Bay Tree)
Yellowhead County (Edson)
County of Minburn No. 27 (Vegreville)
If your jurisdiction is not listed, please list it here:
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you agree to becoming a part of the IMPACT mailing list
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If you have any questions regarding your membership please email impact@sagesse.org
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