Member Reinstatement Application
Personal Information
Full Name
*
First Name
Last Name
Personal Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Alt. Phone Number
Please enter a valid phone number.
Mailing Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Previous CMMOTA Membership Number:
Use 0000 if you do not know.
Class of Membership to Be Reinstated:
*
Full/Registered Massage Therapist/Spa Therapist
Student Massage Therapist
Associate Massage Therapist
Inactive Massage/Spa Therapist
Combined Member (RMT/MOT)
Manual Osteopathic Therapist
Vulnerable Sector Check or Receipt (if applicable)
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Vulnerable Sector Checks must have been obtained in the last 90 days.
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Standard/Intermediate First Aid Level C CPR or Confirmation of Course Date (if applicable)
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Professional Information
The following information will be posted on the website under "Find a Therapist."
Business Name
Business Website
eg., www.cmmota.com
Business Email
example@example.com
Business Phone Number
Please enter a valid phone number.
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like us to add this to your profile?
Please Select
Yes
No
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Have you ever been a member of a professional association or massage therapy college?
*
Yes
No
If yes, please name association(s) / college(s), your membership number, and when you had a membership:
*
Please provide a letter of good standing, if you have one:
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Has a professional association or college ever denied you admittance into their organization?
*
Yes
No
If yes, please state the organization and their reasoning:
*
Has your membership ever been cancelled with a professional association or college?
*
Yes
No
If yes, please state the organization and their reason for cancellation:
*
Did you ever have a complaint filed against you while being a member of a professional association or college?
*
Yes
No
If yes, please state the organization involved and describe the details of the complaint:
*
Are you a Canadian Citizen?
*
Yes
No
If no, please provide proof that you are eligible to work in Canada:
*
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Is English your First or Primary Language in the workplace? If no, proof will need to be submitted to show that you can meet our Language Fluency policy
*
Yes
No
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Personal Information Protection Act (PIPA)
In order to provide and improve member services, CMMOTA collects personal and business- related information form the Membership Application. By signing this form, you are providing you consent for CMMOTA to use and publish your personal information, with the exception of your date of birth and personal contact information (if it differs from your business contact information). The consent provided by you to use your personal and business information will continue throughout the duration of your Membership with CMMOTA unless revoked in writing, in which case such notice must be delivered to the CMMOTA Head Office. The information collected by CMMOTA will be used for the purposes of promotion of the membership and membership services, statistical and membership analysis, communicating with third parties in association with the business operations of CMMOTA, regulation and enforcement of the Bylaws and Policies of CMMOTA (as may be amended from time to time), and any other purpose that supports the Objects and business of CMMOTA and its Membership. The signature below is to be considered as consent to the collection, use and disclosure of personal information as described. The signature below is also considered as consent for the Canadian Massage & Manual Osteopathic Therapist Association business contact information and treatment types available in various formats as required from time to time, including the Find a Therapist area of the CMMOTA website.
*
First Name
Last Name
I, the undersigned, declare that the information provided, and statements made in this application and any attached documents are true.
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
Requested Effective Date
*
-
Month
-
Day
Year
*Effective Dates cannot be before the submission of your application*
How did you hear about CMMOTA?
Remember to list a name if someone referred you!
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