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Membership Plan

Regular Membership - 1 Year

Physicians, nurses, other health professionals and biomedical scientists.

CAD 500.00 per one calendar year

The first period will be Year 2023 (valid from now on)

Regular Membership- 3 Year

Physicians, nurses, other health professionals and biomedical scientists.

CAD 1350.00 per 3 calendar years

The first period will be Years 2023 - 2025 (valid from now on)

Trainee Membership

Medical and graduate students, residents and post-doctoral or research fellows holding a training position and/or with an interest, in Canada, related to gastroenterology or gastrointestinal research.

Year 2023 (valid from now on) for CAD 50.00

International Trainee Membership

Graduate students, residents and post-doctoral or research fellows holding a training position, outside of Canada, related to gastroenterology or gastrointestinal research.

Year 2023 (valid from now on) for CAD 50.00

Affiliate Membership

Nurses, other health professionals and biomedical scientists living outside Canada and physicians living outside of Canada. Physicians living in Canada must apply for a Regular Membership.

Year 2023 (valid from now on) for CAD 300.00

Applicant Details
Username
Salutation	Dr. Mr. Mrs. Ms. Miss. Prof.
First Name
Middle Name
Last Name
Email
Password
Institution
Job Title	Physician Scientist/Researcher Dietician Nurse Practicioner

Preferred Mailing Address In accordance with federal regulations effective January 1, 2004, the CAG is required to keep confidential all personal information provided by its members (unless authorized otherwise), and to disclose how this information will be used.
Company Name (if applicable)
Street Address
Street Address 2
City
Province/State
Country
Postal Code/Zip
Primary Phone
Office Phone
Receive Monthly Member News	Yes No
Receive all other Email Newsletter Communication	Yes No
Receive Survey Requests	Yes No
Share Info with Canadian Digestive Health Foundation (CDHF)	Yes No
Receive Journal	Yes No
Allow Database Search	Yes No

Education Details
Education History
Select all that apply	MD or Equivalent PhD or Equivalent DD DVM Other
If answered Other, please describe
Undergraduate Education
Name of Undergraduate Institution
Undergraduate Degree
Graduated/Expected Graduation Year
Medical/Postgraduate Education
Are you currently in progress or have completed this level of education/training?	Yes No
Name of Medical/Postgraduate Institution
MD/Postgraduate Degree
Graduated/Expected Graduation Year
Training
Training	Gastroenterologist General Surgeon Other
If answered Gastroenterologist	Adult Gastroenterologist Pediatric Gastroenterologist
If answered General Surgeon	Adult General Surgeon Pediatric General Surgeon
If answered Other, please describe
Residency
Are you currently in progress or have completed this level of education/training?	Yes No
Internship/Residency Location #1
Inclusive Dates (e.g. 2001-2003)
Internship/Residency Location #2
Inclusive Dates (e.g. 2001-2003)
Training
Are you currently in progress or have completed this level of education/training?	Yes No
GI Fellowship Training Institution
Completion Year
What year of GI fellowship training are you in?	1st Year 2nd Year 3rd Year 4th Year Other
Program Director
Program Director Email Address

Biography Details
Primary Work Setting	Clinical Research Other
Clinical
If answered Clinical: In Hospital?	Yes No
If answered Clinical: Out of Hospital?	Yes No
If answered Other to Primary Work Setting, please describe?
Principal Fields of Activity/Interest	Clinical Practice Intestinal Disorders Neurogasteroenterology & Motility Nutrition & Obesity Growth Development & Aging Imaging & Advanced Technology Esophageal, Gastric & Duodenal Disorders Pancreatic Disorders Liver & Biliary Gastrointestinal Oncology Immunology, Microbiology & IBD Hormones, Transmitters, Growth Factors & Their Receptors Other
Other Activity/Interest
MD Specialty/PhD Discipline
Professional/Training Activity Please indicate the percentage of time you spend in each of the following professional actitivies (total should not exceed 100 percent)
% Teaching
% Patient Care
% Research: Basic or Translational
% Administrative Management
% Other Activity
Activity Total Percentage	0
Which of the following primarily describes your work setting?
If answered Other to the above question, please describe
Primary Professional/Training Activity
If answered Other to the above question, please describe
Subspecialty
If answered Other to the above question, please describe

Demographics The CAG will report on summary demographic statistics only. Be assured, all individual responses will be kept confidential.
Which of the following BEST describes your ethnic background? Check all that apply	Indigenous (Inuit/First Nations/Métis) White/European Black/African/Caribbean Southeast Asian (e.g., Chinese, Japanese, Korean, Vietnamese, Cambodian, Filipino.etc) Arab (Saudi Arabian, Palestinian, Iraqi, etc) South Asian (East Indian, Sri Lankan, etc) Latin American (Hispanic or Latino) West Asian (Iranian, Afghani, etc) Other Prefer not to answer
Gender	Man Women Non-Binary Prefer to self-describe below
Gender - Prefer to Self-Describe Option
Year of Birth

Credentials Please submit at least one of the following files: for Regular and Affiliate members, a copy of your license to practice, certificate, appointment letter for Trainees and International Trainees, a letter from your program director (for residents and fellows) or your supervisor (for basic science trainees). PLEASE ENSURE ALL ATTACHMENT FILE NAMES CONTAIN ONLY LETTERS and NUMBERS AND NO SPECIAL CHARACTERS For security reasons, our system does NOT accept submissions that contain any special characters, which includes any and all Symbols, Accent Marks and Punctuation marks including: - !* # ; ? \ / : " < > \| . + & ^ % ` PLEASE ALSO ENSURE THAT ALL ATTACHMENTS ARE PDF FILE EXTENSIONS ONLY.
File Upload 1
Your file must be of pdf type. Your file should not exceed 3 MBs. Select file By uploading, you certify that you have the right to distribute this file.
Your file must be of pdf type. Your file should not exceed 3 MBs. Select file By uploading, you certify that you have the right to distribute this file.
Your file must be of pdf type. Your file should not exceed 3 MBs. Select file By uploading, you certify that you have the right to distribute this file.

Privacy Policy

As a member of the CAG, we ask that you provide us with certain personal identifiable information that can be used to contact or identify you (personal Data). Personal identifiable information may include but is not limited to: Email, First Name, Last Name

We may use your personal data to contact you with monthly newsletters, marketing promotional material, conference material, scientific sessions and other information that may be of interest to you. This information will not be used for any other purpose other than the above by the CAG.

You may opt out of receiving any of these communications from us by following the unsubscribe link or the instructions provided in such email sent.

Terms and Conditions

I certify the CAG to use my personal data to send me newsletters, marketing promotional material, conference material, scientific sessions, and other information that may be of interest to me. I understand I can unsubscribe anytime. I authorize that the above information and document(s) provided in this CAG Membership Application Form is true and accurate.

Electronic Signature

By checking this box and typing my name, I certify that I am the person accessing this webpage, submitting this form, and that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature.

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Date

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Applicant Details

Preferred Mailing Address

Education Details

Education History

Undergraduate Education

Medical/Postgraduate Education

Training

Residency

Training

Biography Details

Professional/Training Activity

Demographics

Credentials

Privacy Policy

Terms and Conditions

Electronic Signature