Declaration of Change in Membership and/or Licence Status (previously called Retiring CLS Checklist)

Declaration of Change in Membership and/or Licence Status (previously called Retiring CLS Checklist)

Name

First NameLast Name

Primary Email

example@example.com

Alternate Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Select that which applies

I would like to cancel my licence and maintain a regular membership with ACLSI would like to cancel my licence and move to a retired membership with ACLSI would like to cancel my licence and membership completely **I would like to cancel my membership (I currently do not have a licence) **

** Please Note : If you decide not to renew your Membership and/or Licence to Practice, a reinstatement fee of $175 or $250 each for Membership and Licence will apply if you later return to practice. However, by submitting this form before your Membership and Licence expire on December 31, you will avoid all other penalties.

Please consult the ACLS Bylaws for the process and applicable fees.

We encourage you to consider retaining a Retired Membership ($100/year). This option allows you to avoid the $175 or $250 reinstatement fee for Membership (the licence reinstatement fee would still apply) and allows you to:

Stay connected with your professional community and continue to have a voice in ACLS
Contribute your experience and perspective to strengthen the surveying profession.
Your ongoing involvement, even in retirement, makes our association stronger.

Thank you!

1. Do I have unfinished project(s) on Canada Lands or private lands in the territories?

YesNo

(the word “unfinished” means projects were there is a need for more tasks to be performed by CLS to satisfy a client requirements such as for example a project where monuments have been placed but no plan was drafted or field notes recorded.)

If yes, have you made arrangements for the project(s) to be taken over by another licensed CLS?

YesNo

If yes, what is the name & email of the CLS?

Note: If in a project, you placed survey monuments in the field but no plan was recorded in the CLSR, the Association strongly recommends that you record field notes so that other surveyors may refer to these in the future.

2. Do you have survey document(s) that are destined to be recorded but are held up for reasons such as waiting for approval(s) or signature(s) for example?

YesNo

If yes, have you made arrangements for the project(s) to be taken over by another licensed CLS?

YesNo

If yes, what is the name & email of the CLS?

3. If you did not practice as a federal or provincial public servant, did you make arrangements to protect yourself and your close ones financially by securing past action professional liability insurance?

YesNo

4. Please provide the location of where your survey files will be stored:

Note: If you have questions or concerns about the above mentioned items, please contact the Association of Canada Lands Surveyors Registrar for assistance at registrar@acls-aatc.ca

Declaration
I, the applicant, hereby declare that:
The information provided in this application and all supporting documentation is complete, accurate, and true to the best of my knowledge and belief.

I understand that any false statement, misrepresentation, error, or omission may result in the refusal, suspension, or revocation of a license to practice, and may be grounds for disciplinary action by the Association of Canada Lands Surveyors (ACLS).

I acknowledge that it is my responsibility to ensure that all obligations and requirements under the Canada Lands Surveyors Act, associated Regulations, and the ACLS By-laws have been met.

I further acknowledge that my license to practice is conditional upon continued compliance with these governing authorities.

By submitting this application electronically, I agree to the above declaration and attest that my submission constitutes my legal signature.

I agree to the Declaration above.

YesNo (your submission will not be processed)

Please keep a copy of this Declaration as proof of cancellation or change in licence or membership status. You will also receive a copy of your submission by email.