General Membership Registration – Canadian Association of Equine Dental Practitioners Inc.

CAEDP Registration - My Information

Username *

Only lower case letters (a-z) and numbers (0-9) are allowed. You will also be able to login with your email address.

Email Address *

Enter Email

Confirm Email Address *

Confirm Email

Password *

Enter Password

Confirm Password *

Confirm Password

Name *

First

Last Name *

Last

Business Name

Mailing Address *

Mailing Address

City

State/Province

Zip/Postal

Country

Physical Address *

Physical Address

City

State/Province

Zip/Postal

Country

Business Phone Number *

Cell Phone Number *

Website/URL

Date of Birth *

Gender *

How did you learn about CAEDP?

Have you previously enrolled in CAEDP’s Certification Program? *

Yes

Date Completed? *

What components have you completed? *

Are you a past or present member of any other equine dental association? *

Yes

Please list the associations you are a past or present member of *

Are you certified with any other equine dental association? *

Yes

Please list the equine dental associations which you are certified with *

Please list transferable credits/requirements *

Grandfathering Eligibility? *

Yes

Additional Information

I certify that the information and documentation submitted in or with this application or to be submitted (all of which together constitute the application) are true, complete and correct and that all information relevant to a decision on the application has been disclosed. I understand that it is my responsibility to keep CAEDP informed of any relevant changes to my information and I agree to do so immediately after any such change occur. I agree that my application for admission constitutes my acceptance of the admission requirements, policies and procedures and of the methods by which applicants are chosen.

I authorize and consent to verification of any information provided to the Canadian Association of Equine Dental Practitioners as a part of this application and to collect, use and disclose my personal information for the exclusive purposes relevant to this application. I understand that the discovery that any material information has been concealed or that any given information is false or misleading could invalidate my application and result in immediate rejection, or revocation of my admission.

Signature

Clear

Date *

If you are human, leave this field blank.

CAEDP General Membership Registration

CAEDP Registration - My Information