Dues Notice - 2011

NOTE: Fill in the your information first, then print a hard copy to fax.

Name:

Mailing Address:

Phone:

Fax:

E-mail:

*** I would Like to receive my newsletter by:

E-mail           Regular mail

Membership Classification:

A)

Active Member   $45.00

Registered by a national examination in one of the following disciplines. Please specify.

  R.E.T.
R.EP.T.

 R.EEG.T
R.PSG.T.

R.T.(EMG)
         Other

B)

Associate Member   $45.00

Registration not completed / retired

C)

Student Member   $20.00

Currently in training

Please make cheque payable to B.C.S.E.T. and return this completed form to the address below.