Demographics
The association will only report summary demographic statistics. All individual responses will be kept confidential as required by federal PIPEDA regulations.
Arab (Saudi Arabian, Palestinian, Iraqi, etc)
Black/African/Caribbean
Indigenous (Inuit/First Nations/Métis)
Jewish (Ashkenazi, Sephardic, Mizrahi, etc)
Latin American (Hispanic or Latino)
South Asian (East Indian, Sri Lankan, etc)
Southeast Asian (Chinese, Japanese, Korean, Vietnamese, Cambodian, Filipino, etc)
West Asian (Iranian, Afghani, etc)
White/European
Prefer not to answer
Other
,
Credentials
Please submit at least one of the following files:
Regular and Affiliate membership - a copy of your license to practice, certificate, appointment letter.
Trainees and International Trainee membership - a letter from your program director (for residents and fellows) or your supervisor (for basic science trainees).
Privacy Policy
The information you provided will be used to assess your eligibility for membership by the CAG’s Admissions Committee.
As a member of the CAG, we may use your personal data (including but not limited to Email, First Name, Last Name) to contact you with email communications, such as 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 email communications from us by updating the correspondence options in your profile.
Terms and Conditions
I certify the CAG to use my personal data to send me email communications. I understand I can opt out anytime.
I authorize that the above information and document(s) provided in this CAG Membership Application Form is true and accurate.
KEEP CURRENT Electronic Signature COPY
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.
Electronic Signature (type full name)