ACLS Membership Application or Reinstatement

Do you hold a Canada Lands Surveyor (CLS) Commission?

YesNo

Please enter your CLS commission number:

Please select which applies to you:

First time applicant - I have never held a membership with ACLSI have had a membership in the past but it has lapsedI currently hold a Retired membership with ACLS and would like to switch to a Regular membershipI would like to apply to become a Student MemberI would like to apply to become an Associate Member (CLS are not eligible for Associate Membership)

For Student (Candidate) membership, please apply at https://form.jotform.com/241974251914056

For Reinstatement of Membership

Reinstatement of lapsed membership (if not declared in advance) $250.00 plus any membership fees owing (at the Retired Member rate) for years lapsed, up to three years, in accordance with the ACLS Bylaws.

Name / Nom*

First Name / PrénomLast Name / Nom de famille

Personal Address / l'adresse personnelle*

Street Address / Adresse

City / VilleProvince / la province

Postal code/ Poste

Personal Phone Number / téléphone personnel*

Company or Employer / Entreprise ou employeur

Office Address / Adresse du bureau

Street Address / Address

Street Address Line 2

City / VilleProvince / la province

Postal code / Poste

Office Phone Number / Numéro de téléphone du bureau

Email*

example@example.com

Please upload a PDF or jpg of the email confirmation for your DECLARATION OF CHANGE IN MEMBERSHIP AND/OR LICENCE STATUS. The upload must show the date of your declaration.

Please upload a government issued photo identification / Veuillez ajouter une pièce d'identité délivrée par le gouvernement

Do you hold a Provincial Commission / Détenez-vous une brevet d’arpenteur-géomètre provincial?*

Yes / OuiNo / Non

In which province do you hold a Commission? / Dans quelle province êtes-vous titulaire une brevet d’arpenteur-géomètre?*

Date your Commission was issued / Année d’émission du brevet*

Date

Members are required to respond to this questionnaire in accordance with the Canada Lands Surveyors Regulations (SOR/99-142), Section 2 and 3 (1). A CLS must annually complete the Declaration of Good Character, in order to renew their membership. / Les membres sont tenus de répondre à ce questionnaire conformément aux articles 2 et 3 (1) du Règlement sur les arpenteurs des terres du Canada (DORS/99-142).Les candidats ATC acceptés doivent également remplir le Questionnaire de bonne conduite. De plus, les ATC doivent remplir la Déclaration de bonne conduite chaque année afin de renouveler leur adhésion.

Do you have any current criminal charges against you in Canada or other jurisdictions? / Faites-vous actuellement l'objet de poursuites pénales au Canada ou dans d'autres juridictions?*

Yes / OuiNo / Non

Have you ever pleaded guilty or been convicted of a criminal offence in Canada or other jurisdictions where a pardon has not been granted? / Avez-vous déjà plaidé coupable ou été condamné pour une infraction pénale au Canada ou dans d'autres juridictions où un pardon n'a pas été accordé?*

Yes / OuiNo / Non

Do you have any current criminal charges against you in Canada or other jurisdictions? / Avez-vous des plaintes en cours, des enquêtes sur des plaintes ou des procédures disciplinaires auprès d'un organisme ou d'une agence de réglementation professionnelle?*

Yes / OuiNo / Non

Have there been any other situations in which your good character has been called into question? / Avez-vous déjà été confronté à d'autres situations dans lesquelles votre bonne réputation a été remise en question?*

Yes / OuiNo / Non

Have you ever been suspended, required to withdraw, expelled or penalized for misconduct from an academic institution? Avez-vous déjà été suspendu, contraint de vous retirer, expulsé ou sanctionné pour mauvaise conduite par un établissement d'enseignement?*

Yes / OuiNo /Non

Do you have any outstanding complaints, complaint investigations, or disciplinary proceedings with a professional regulatory organization or agency? / Avez-vous des plaintes en cours, des enquêtes sur des plaintes ou des procédures disciplinaires auprès d'un organisme ou d'une agence de réglementation professionnelle?*

Yes / OuiNo / Non

Have you ever been found guilty of unprofessional conduct or unskilled practice by a professional regulatory organization or agency resulting in loss of practice? / Avez-vous déjà été reconnu coupable de manquement à la déontologie ou de pratique non conforme par un organisme ou une agence de réglementation professionnelle, entraînant la perte de votre droit d'exercer?*

Yes / OuiNo / Non

If you have answered “yes” to any of the above questions, page please provide a brief description below and any factual information regarding the complaint, professional misconduct, criminal charge, conviction and/or criminal offence. Please also describe all of your rehabilitation or self-improvement activities. You may be contacted directly, should additional information be required by the Registrar. / Si vous avez répondu « oui » à l'une des questions ci-dessus, veuillez fournir ci-dessous une brève description et toute information factuelle concernant la plainte, la faute professionnelle, l'accusation pénale, la condamnation et/ou l'infraction pénale. Veuillez également décrire toutes vos activités de réadaptation ou d'amélioration personnelle. La registraire pourra vous contacter directement si elle a besoin d'informations supplémentaires.

ACLS is committed to protecting your right to privacy.The information that you provide to ACLS is collected and protected in accordance with the Association of Canada Lands Surveyors (ACLS) Privacy Code and in full compliance with the Personal Information Protection and Electronic Documents Act (S.C. 2000, c.5).

Excerpt from ACLS Bylaws:

12.1 ANNUAL Dues and Fees of the Association which correspond to the fiscal year of the Association are:
(1) Annual Dues:
(a) Regular Member $420.00
(b) Retired Member $100.00
(c) Associate Member: $100.00

12.2 Other Fees of the Association are:
(k) Reinstatement of lapsed membership or license (if not declared in advance) $250.00 each plus any membership and license fees owing for year(s) lapsed (up to three years).

12.4 Penalties are:
(a) late payment of annual dues or license - 50% of the dues or license
(3) Penalties do not apply to those who have provided the Association with appropriate notice of their intent to not renew and who may change that intent in future.

PAYMENT*

REGULAR AND ASSOCIATE MEMBERSHIP

REGULAR Membership: Must hold a Canada Lands Surveyor (CLS) Commission $420

$420.00CAD

REGULAR Membership: Must hold a Canada Lands Surveyor (CLS) Commission $420 (reduced by 50% after July 1st NEW MEMBERS ONLY)

$210.00CAD

ASSOCIATE Membership: For persons who have an interest in the surveying profession but do not hold a CLS Commission $100 (non CLS)

$100.00CAD

REINSTATEMENT AS A REGULAR MEMBER

Regular Membership: SWITCHING from Retired Member to Regular Member during the current membership year $420 - $50 credit from Retired Membership duesMarch through December

$370.00CAD

Penalty - Reinstatement (if Membership lapse was not Declared in advance)

$250.00CAD

Fees owing for years lapsed / Back Dues - Up to 3 Years at the Retired Member rateRequired if Membership lapse was not Declared in advance

$150.00CAD

Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD

By pressing SUBMIT and paying the fee associated with ACLS membership, I declare that the above information contained in this application is true and correct to the best of my knowledge.

ACLS Membership Application or Reinstatement

DECLARATION OF GOOD CHARACTER / DÉCLARATION DE BONNE CONDUITE

FEES / FRAIS