CAMACS Membership application form

Membership Application (CAMACS)

Canadian Association of Medical Spas and Aesthetic Surgeons.
Application Purpose
Application type
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
Home Number

Area Code Phone Number
Cellular Number

Area Code Phone Number
Work Number

Area Code Phone Number
Your most recent education / Diploma
Have you declared bankruptcy in the last 5 years
Are you a clinic / Business Owner?
Website:
if applicable
Please type few examples of procedures you have performed:
Please indicate your experience and affiliation with Aesthetic Medicine
Are you a member of other professional organizations / Associations? if Yes please name it.
Would you like your personal or business name to be posted on the CAMACS website?
Upload files if necessary

Browse Files
CVs / Diplomas/ Certificates/ Credentials/ etc. Cancel of
Method of Payment

PayPal E-transfer Cheque Credit Card
Credit Card Information
Name on Credit Card
Credit Card Number
Expiry Date
3-digit Security code on the back
Signature

Clear
Signature date
Should be Empty:

Membership Application (CAMACS)