Membership application

Step 4 of 4

Chart for application fees*

Subscription Amount fee as of (no taxes are applicable).

Application from the month of:*

December (4 months - $ 70.00)
January (3 months - $ 52.50)
February (2 months - $ 35.00)
February (14 months - $ 245)
March (13 months - $ 227.50)

Payment choice*

Credit card
Interac e-Transfer

Credit card*

American Express

Discover

MasterCard

Visa

Card number Expiration date Security code (CVV) Name of cardholder

Enter the name of the person holding the bank account that will be used to make the payment:*

Entry into force of the membership status:*

I understand that my membership application will be processed in 1-2 business days, but my membership status will be effective only from the membership month selected above.

INTERAC PROCEDURE
To make an Interac transfer, log in to your financial institution's transactional platform and enter the information below :

1. Email : comptabilite@rmpq.ca

2. Amount :Enter the amount for the month of your membership in the chart above.

3. Secret question : * Attention * Enter the full name of the person applying for membership at the location provided for the security question.

4. Answer : rmpq2285

Please note that your request will not be processed until we receive your payment.

Month of December (4 months)

Price:

Month of January (3 months)

Price:

Month of February (2 months)

Price:

Month of February (14 months)

Price:

Month of March (13 months)

Price:

Membership Terms

Professional Covenant | Acknowledgement of the authority of the Disciplinary Committee and the Board of Directors | Limited Consent for Disclosure of Information to Third Parties*

• I certify that I am 18 years of age or older and that I am the person applying for membership to the Réseau;
• I certify that all information provided is true and complete, and I understand that any falsification of information on this application will result in cancellation of my membership and privileges as a member of the Réseau;
• I agree to keep my contact information up to date at all times;
• I agree to abide by the Réseau's Code of Ethics as well as the general regulations and to any changes thereto that may be brought from time to time;
• I acknowledge the authority of the Disciplinary Committee and the Board of Directors with regard to my conduct if I violate any terms of the Code or regulations.
• If applicable, I agree to abide by the disciplinary process and I acknowledge the authority of the Disciplinary Committee and the Board of Directors over me.
• I consent to the provision of a notice to visitors to the Réseau's website, to Réseau Members, to any insurer and any plaintiff, with respect to any penalty that may be imposed on me and the reasons for such a penalty;
• These covenants, acknowledgements and consents shall be valid so long as I am a member of the Réseau and therefore apply to any renewal of my membership.

I acknowledge that I have read the membership terms and accept them.

Personal Data Privacy Policy:*

I hereby authorize the Réseau des massothérapeutes professionnels du Québec to retain my personal data transmitted via this form as well as all other means of communication available to us in accordance with the provisions of Law 25. You have the right to access and rectify the information about you. If you wish to exercise this right and obtain disclosure of your personal information, please contact us at edurand@rmpq.ca. You can view our Personal Data Privacy Policy.

I accept the terms of the above Personal Data Privacy Policy.

Name*

Date*

Your membership form has been sent. Allow 1-2 business days for:

1. Analysis of your file

2. Receive your Obtaining your membership number and confirmation of your status as a regular member by e-mail.

Step 1 of 4

Step 2 of 4

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Step 4 of 4

Chart for application fees*

Membership Terms