PSAP inscription form with application

Personal address
Gender*
- Mr.
- Mrs.
Name*
First Last
Date of birth*
Address*
Civic number, Street, Apartment number City Province Postal code
Address confirmation*
- I confirm that the address above is complete and includes my apartment or rental space number if applicable.
Phone*
Cell phone
Fax
Email*
Payment
Payment choice*
- Credit card
- Interac Transfer
Credit card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card number Expiration date Security code (CVV) Cardholder name
Please note that your request will not be processed until we receive your payment.

Total inscription PECP : $ 100 ($ 114.98 taxes included)

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
Total PSAP inscription with application
Price:
Taxes included.
Commitment
Commitment*
I pledge to:
• Make payment related to PECP according to the applicable rate, before the theoretical and pratical assessements.
• Respond to electronics theory test.
• Perform pratical exam and be accompanied with a volunter. You mus bring with you: sheets, oil, file and anything else useful fot the realization of care.
• Join the Réseau des massothérapeutes professionnels du Québec at the end of the process and respect the code of conduct and the general regulations at the Réseau.
• I certify that I am 18 years old.

The Réseau committed to:
• Conduct theoretical and pratical examinations and provide a space, a table and an evaluation for their realization.
• Admit as a member therapist who completed the process who meets the eligibility criteria.
• To give the therapist a letter stating his fields of pratice after successful evaluation and admission as a member.
• In case of failure assessments, the Réseau agrees to make recommendations to therapist about possible improvements
to their application.
I acknowledge that I have read the terms and accept them.
Name*
First Last
Date*
DD slash MM slash YYYY
Allow 1-2 business days for:

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

Personal address

Payment

Commitment