Apply/Renew Membership

Membership Type: *

Apply New Memebership
Renew Membership

First Name: *

Last Name: *

Mailing Address: *

City *

Province: *

Post Code: *

(e.g., "T2X 1V4" or "T2X1V4")

Work Telephone: *

Extension (if any):

Ext Number:

Home Telephone: *

Fax:

Email: *

Degree/Certificate/Diploma:

Current Employment:

Profession/Position:

Employment Type:

Name of organization:

Membership Category: *

  Full Member ---- $125.00
  Associate Member ---- $87.50
  Auxiliary Member ---- $50.00
  Student or New Professional (new category) ---- $50.00
  Retired Member - (Age 60+ and 10 years membership and retired from practice) - 50% discount on Regular Dues

Please indicate if you would like to receive:

  Membership Card
  2010 Membership Seal
  Information about upgrading your membership category

Application Form:

Updated CV:

Letter of Reference 1:

Letter of Reference 2:

Proof of Student Enrollment or Graduation:

NEWS

Regional Sections: