Application form

Fill out the below application form and print this page

C.C.O.S.(C)

COLLEGE OF CHIROPRACTIC ORTHOPAEDIC SPECIALISTS (Canada)
COLLEGE DES SPECIALISTES EN ORTHOPEDIE CHIROPRATIQUE (Canada)

MEMBERSHIP APPLICATION

Name:

Date of Birth:

Address:

City:

Province:

Postal Code:

Telephone: Office: ()

Residence: ()

Fax: ()

Chiropractic College:

Grad year:

Email address:

Orthopaedic Program:

Have you been involved in a post-graduate orthopaedic program? YES NO
College:Date of Completion:

Diplomate of the American Board of Chiropractic Orthopaedists
YES NO Date of Certificate:

Other education and degrees:

Other professional association memberships:

I hereby apply for membership in the COLLEGE OF CHIROPRACTIC ORTHOPAEDIC SPECIALISTS (Canada) and have enclosed evidence of my qualifications for the category of FELLOW , MEMBER , ASSOCIATE MEMBER. I understand that the failure to remit dues will result in loss of membership and all rights/privileges thereof indicated in the by-laws of the C.C.O.S.(C)

Signature:

Date:

Active Fellow $200.00
Associate Member $100.00

Make cheques payable to the C.C.O.S.(C) and send to:
Dr. Inger Simonsen, DC, FCCOS(C), RAc
187 Madison Avenue, Toronto, ON M5R 2S6
Tel : 416.961.5571
Fax : 416.929.6606

Print Form

News

Applications are now being accepted for candidates for Fellowship. There are now standing annual application deadline dates of April 30, August 31, and December 31.
For Graduate Studies information please click:

See application package