DECLARATION OF CHANGE IN MEMBERSHIP AND/OR LICENSE STATUS

DECLARATION OF CHANGE IN MEMBERSHIP AND/OR LICENCE STATUS

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

If you plan to obtain a license to practice again at a later date please note the process located in the bylaws and fees applicable. Application, reinstatment, assement and other fees may apply.

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 and Attestation
I, the applicant, hereby declare that:
The information provided in this application and in all supporting documents 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 and Attestation above.

YesNo (your submission will not be processed)

Please keep a copy of this declatation as proof of cancellation or change in license or membership.