CSRT Membership
 
    Home     Contact Us
Media     Français

Membership Benefits

Membership Data

Membership Dues
Create your Profile

Contact Information

Prefix: 
First Name: 
 required
SurName: 
 required
Email: 
 required
Telephone (Home): 
 required
Telephone (Work): 
Fax: 
Cell Phone: 
Gender: 
 required
Birthdate: 
 required (mm/dd/yyyy)

Home Address

Address: 
 required
 
City: 
 required
Province: 
 required if US or Canada
Postal Code: 
 required if US or Canada
Country: 
 required if not Canada

Current Education Program

Anticipated Graduation Date: 
 required
Institution: 
 required
Name on Certificate: 
 required
Cert Language: 
 required

Background Information

The following questions must be answered yes or no. All yes answers must be accompanied by a detailed explanation (please email separately).

Have you ever been charged with a criminal offence for which you have not been pardoned?: 

 Yes  No required

If you hold a professional or other designation, have you ever had your certificate,
license, registration or other authority rejected, revoked, suspended or modified?: 

 Yes  No required

Additional Information

  I do not wish to receive issues of the CJRT


  I prefer correspondence from the CSRT by e-mail where possible.


  Please send future correspondence in French where possible.

Disclaimer

 

I hereby certify that the information provided is accurate and true. I authorize the CSRT to pursue additional inquiries required to complete this application process. required

Continue