How to Become a Member

Institute information will be sent to your personal email address and not your work email address in order to protect your privacy.

Information

Title

First Name

Last Name

Date of Birth

Gender

How I self-describe:

Language Preference

Employer

Classification

Effective Date of Employment/Acting in this Classification

Special Needs

(eg. hearing or visually impaired)

Home Mailing Address

(Home) Address

Apt

City

Province

Postal Code

Telephone (Include Area Code)

Cell (Include Area Code)

Personal E-mail Address

Work Address (actual physical address)

(Work) Building

Address

City

Province

Postal Code

Telephone (Include Area Code)

Ext

Cell (Include Area Code)

Work E-Mail Address

Education

Degrees

Professional Designations (i.e. R.N., CGA, P.Eng)

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