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


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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)

 

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

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