Application For Student Membership (For Ontario Students only)

Name: Mr. Mrs Miss Ms (Surname/Given) (First) Date of Birth: [Day / Month / Year]

Mailing Address:

City & Postal Code:

Telephone:

Discipline: Radiological Technology Nuclear Medicine Radiation Therapy Basic Radiological Technician

Primary E-mail Address:

Name of Educational Institute:

Name of Primary Clinical Site:

* What Date Does Your Program Begin? Month / Year

* What Date Are You Expected to Graduate? Month / Year

Signature:

Signed at (Place):

Date: [ Y/M/D ]

PRIVACY PERSONAL INFORMATION COLLECTION: The OAMRT collects personal information from Members for the purposes of determining, and maintaining Membership, providing information on OAMRT events, and services, and mailing OAMRT publications. The OAMRT may share this information with the CAMRT and other Provincial Member Associations, for the purposes of verifying, and maintaining Membership records. From time to time, the OAMRT makes its Membership List available to third parties (Association partners) for the following commercial purposes: Job Recruitment Advertising, promotion of Education Activities, and Benefit Services. The lists include Members' names, and preferred mailing addresses only. If you do not want your name to be made available, contact the OAMRT Privacy Officer at 1-800-387-4674 Ext. 106. Please check box if you do not want your name made available for the above mentioned commercial services. *If you say "no" and you are not getting job information, or other beneficial information other Members receive, then you will need to call the OAMRT Privacy Officer to have your status changed. CAMRT, like the OAMRT, respects your privacy, and your personal information will be treated in accordance with CAMRT’s Privacy Policy, found on CAMRT’s Web Site (www.camrt.ca) under ‘About CAMRT’.

NOTES:

1. Your E-mail address is your access to the Members Only Section of the OAMRT Web site (www.oamrt.on.ca), which has a multitude of useful links and information you can utilize. If you change your E-mail address, please notify the OAMRT Head Office at 1-800-387-4674 Ext. 109.

2. You are entitled to the Benefit Program as a Member.

3. You have voting rights at Section meetings.

4. You have reduced rates, as a Member, to OAMRT sponsored education activities.

5. You have access to the M.E. (Beth) Wastle Research Bursary.

6. You may enter OAMRT Student Essay and Exhibit Competitions.

7. As a Student Member of the OAMRT, you are automatically a Student Member of the CAMRT. The Canadian Association of Medical Radiation Technologists (CAMRT) is the national certifying body and professional association of Canadian Medical Radiation Technologists (MRTs). For more information about CAMRT, please visit CAMRT’s Web Site at www.camrt.ca

DECLARATION

As a Student Member of the OAMRT, I pledge that I will:

• Abide by the Code of Ethics of the Association;
• Abide by the Code of Conduct of the Association;
• Abide by all confidentiality requirements, in terms of legislation, policies, guidelines and procedures, that exist regarding the delivery of education and health care;
• Explore, and determine what the Best Practices are for the Profession, and follow them diligently regardless of pressures, direction or examples to the contrary.

 

Full Name or Email Address of Applicant will be accepted:

Please fill in the blanks above, and click the Submit button below.:

PLEASE NOTE: For administrative purposes, a copy of this completed form will be sent to the Canadian Association of Medical Radiation Technologists (CAMRT) in Ottawa.

FAX: (519) 753-6408

Document last modified:
June 23, 2011