CMMOTA Reinstatement Application

In order to provide, maintain, and enhance member services, the Canadian Massage and Manual Osteopathic Therapists Association (CMMOTA) collects personal and business information through the Membership Reinstatement Application process. By singing this form you consent to CMMOTA’s collection, use and disclosure of your personal and business information as outlined below:
CMMOTA may use and publish your information – excluding your date of birth and any personal contact details that differ from your business contact information – for purposes including:

Promoting CMMOTA membership and member services
Conducting statistical and membership analysis
Communicating with third parties in connection with CMMOTA’s business operations
Enforcing and administering CMMOTA’s Bylaws and Policies (as amended from time to time)

This consent remains valid for the duration of your membership unless revoked in writing. Written notice of withdrawal of consent must be delivered to the CMMOTA Head Office.

By signing below, you also consent to the publication of your business contact information and treatment modalities in various formats as required from time to time, including in the Find a Therapist section of the CMMOTA website.*

First NameLast Name

I, the undersigned, do hereby solemnly affirm that the information provided and the statements contained in this application and any supporting documents are true, complete, and correct. I understand that any misrepresentation, omission, or falsification of information may result in the denial, suspension, or revocation of membership with the Canadian Massage & Manual Osteopathic Therapists Association (CMMOTA).*

First NameLast Name

Today's Date*

Date

Requested Effective Date*

*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!

Member Reinstatement Application

Personal Information

Professional Information

Personal Information Protection Act (PIPA)