CMMOTA Reinstatement Application

  • Member Reinstatement Application

  • Personal Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Class of Membership to Be Reinstated:*
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  • Professional Information

    The following information will be posted on the website under "Find a Therapist."
  • Format: (000) 000-0000.
  • Have you ever been a member of a professional association or massage therapy college?*
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  • Has a professional association or college ever denied you admittance into their organization?*
  • Has your membership ever been cancelled with a professional association or college?*
  • Did you ever have a complaint filed against you while being a member of a professional association or college?*
  • Are you a Canadian Citizen?*
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  • Is English your First or Primary Language? If no, proof will need to be submitted to show that you can meet our Language Fluency policy*

  • Personal Information Protection Act (PIPA)

  • 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)
    • Any other lawful purpose that supports the objectives and business of CMMOTA and its membership.

    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.

  • Today's Date*
     - -
  • Requested Effective Date*
     - -
  • Should be Empty: