Canadian Association of Paediatric Surgeons

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Member Type

First Name

Last Name

Birth Date

Country of Citizenship

Email Address

Home Address

Home City

Home Province or State

Home Postal Code or Zip Code

Home Country

Home Phone & Area Code

University/Hospital Information

University Name

Hospital Name

Permanent Office Information

Permanent Office Address

Permanent Office City

Permanent Office Province or State

Permanent Office Postal Code or Zip Code

Permanent Office Country

Permanent Office Phone Number And Area Code

Permanent Office Fax Number

Password

Confirm Password

Training

General Surgery

Location

Start Date

End Date

Paediatric General Surgery

Location

Start Date

End Date

Certificate of Special Competence, Royal College of Physicians and Surgeons of Canada, American Board of Surgery or equivalent certifying body (please specify):

Yes
No

Date

Certifying Body

Sponsors (names of 2 Active or International members, one must be/have been a mentor in your training program:

Sponsor Name

Sponsor Email

Sponsor Name

Sponsor Email

Please note that only complete applications, including supporting documents from sponsors, will be considered. All applications must be reviewed by the Membership and Credentials Committee and approved by the membership of CAPS at the Annual General Meeting before membership is granted. You will be notified if your application has been approved.