CMAAC Membership Application Form

Practice History

In chronological order, list the name of every jurisdiction where you have practiced TCM and Acupuncture, including all training appointments, since your graduation from TCM school.
Establishment
Dates Employed
Address of Establishment
Contact (Name and Phone Number)
Establishment
Dates Employed
Address of Establishment
Contact (Name and Phone Number)
Establishment
Dates Employed
Address of Establishment
Contact (Name and Phone Number)

Affiliations

List all professional associations with which you have held or currently hold membership.
Association Name
Dates of Membership
Membership Number
Contact (Name and Phone Number)

Declaration

I hereby certify that the above statements are true and correct to the best of my knowledge. I hereby apply for membership to The Chinese Medicine and Acupuncture Association of Canada (CMAAC). In the event of cessation of membership with CMAAC, the membership, being the property of CMAAC will be duly returned.
Date*

MonthDayYear
Applicant's Electronic Signature*
Type your complete name

Membership Fee
Please indicate how you will pay for your membership fee.

ChequeCashMoney Ordere-Transfer
Cheques are to be mailed to:

CMAAC Head Office, 154 Wellington St, London, ON N6B 2K8

For e-Transfer, please contact CMAAC Head Office at headoffice@cmaac.ca or 519-642-1970.
Please submit:
1. Two passport size photographs signed by a credible guarantor
2. Certified copies of credentials (Academic and Clinical)
3. Signed Code of Ethics
4. Copy of Education Transcripts
**PLEASE NOTE: The processing fee for the membership application is NON-REFUNDABLE. As well, certified copies of credentials submitted will NOT be returned.
Should be Empty: