2012 OAP Emeritus, Resident/Student Membership Renewal

2012 OAP Resident/Student or Emeritus Membership Renewal

The 2012 Membership is due on March 31st, 2012.

Although Resident/Student and Emeritus OAP membership is free, we do ask that you confirm your ongoing interest in membership, plus your current contact information, prior to March 31st each year.

The information provided here will be used to update your information on the OAP membership and mailing list.

If you have questions, please contact OAP Treasurer Dr. MacMillan via e-mail at cmacmillan@mtsinai.on.ca

1. Please indicate type of action required, i.e. Renewal or Change of status, contact information

Please indicate type of action required, i.e. Renewal or Change of status, contact information Membership Renewal

Change of status, affiliation or contact information

*
2. What type of membership status?

What type of membership status? Resident/Student

Emeritus

3. Please indicate your hospital/lab affiliation

Please indicate your hospital/lab affiliation Affiliation
City/Town:

*
4. Please provide your contact information. This will be used to provide you OAP Newsletters and AGM information.

Please provide your contact information. This will be used to provide you OAP Newsletters and AGM information. First Name:
Last Name:
Address 1:
Address 2:
City/Town:
Province:
Postal Code:
Country:
Email Address:
Phone Number: