Membership Registration 2017-2018 INDIVIDUAL MEMBERSHIP EXPIRES MAY 31, 2018 MEMBERSHIP YEAR WILL BE JUNE 1 – MAY 31 OF THE FOLLOWING YEAR Please note: Registration must be completed and paid for online below. There is no option to mail or fax your registration. PERSONAL INFORMATIONAre you a first time member?YesNoName* First Last Home Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Your home address will be used to determine the chapter you belong to.Home PhoneWork PhoneEmail (work or home)* Please fill out to receive our e-newsletter and for chapters to send you information regarding meetings/updates. Please use e-mail that you check most frequentlyPROFESSIONAL INFORMATIONHospital / Facility*SiteIf multi-site Facility/Corporation please include siteCity*Position*MEMBERSHIP TYPEPlease select your member type*REGULAR MEMBER: Technician ($30.00)REGULAR MEMBER: Management ($40.00)ASSOCIATE MEMBER ($30.00)REGULAR MEMBER: Those occupationally or professionally involved in instrument/medical device reprocessing in a health-care setting. ASSOCIATE MEMBER: Those not actively involved in instrument/medical device reprocessing in a health-care setting. E.g. - Director of Nursing, Purchasing Agent, Infection Control Officer, Manufacturer's Representative, other allied professions, and those members who have retired. Associate members may not vote or hold office.CHAPTER INFORMATIONChapter is determined by your home addressChapter*DELTA: West to Woodstock, East to Guelph, South to WellandETA: Toronto, West to Milton, East to Ajax, North to Barrie, South to BurlingtonGAMMA: East of Ajax to the Quebec border, North to Ottawa, West to LindseyLAMBDA: North of Sault Ste. Marie to Thunder Bay to the Manitoba BorderSIGMA: London, Sarnia, South to Windsor, West to LeamingtonTHETA: Orillia, North to James Bay, West to Sault Ste. Marie, East to LindseyOUT OF PROVINCE: Anywhere outside of OntarioPlease check one. Please ensure you select a chapter based on your home address.I warrant that the information I have provided on this form is correct.* Yes PAYMENTPlease click the button below. You will be directed to Paypal where you can pay by credit card or your Paypal account. This iframe contains the logic required to handle AJAX powered Gravity Forms.