• Upon completion you will be taken to a payment form to finalize your membership
  • Membership dues are $500.00/year
First Name
Last Name
Email Address (and username to login)
Password (at least 6 characters long)
Primary Phone Number
Cell Phone Number
Hospital Affiliation
Date of Birth
Subspecialty

Home Address

Address
City
Province
Postal Code

Work Address

Address
City
Province
Postal Code



Please click on the checkbox above to proceed.