BCSRT Applicant Personal Info
Verification of successful completion of approved examination. Please enter all applicable registry numbers. If registry number(s) are not entered (when available) the application will be refused and an administration fee assessed.
Primary Identity
Please provide any other surname(s) by which you have been known, or that may appear on your education or certification credentials (eg. a maiden name). If more than one, separate each name by a comma (eg. Smith, Brown)
PRIMARY CONTACT INFORMATION Please provide your primary contact information and indicate the type of information it represents (Home or Work).
Address
Your primary email address is the address to which all official BCSRT email communication will be directed.

IT IS IMPORTANT TO REMEMBER THAT OUR PASSWORD RETRIEVAL SYSTEM WILL SEND YOUR PASSWORD TO THIS AS WELL AS YOUR SECONDARY EMAIL ADDRESS (IF PROVIDED BELOW). IF YOU SHARE THIS EMAIL ADDRESS WITH ANYONE ELSE (A DEPARTMENTAL ADDRESS FOR EXAMPLE) THOSE PERSONS MAY THEN HAVE ACCESS TO YOUR PASSWORD AND THEREBY YOUR PERSONAL MAMRT PROFILE.

If you'd like BCSRT email to be directed to a second address in addition to the primary email address provided above, enter it here.
Enter an extension number here if necessary.
EMPLOYMENT CONTACT DETAILS
Respiratory Therapy
RESPIRATORY THERAPY EDUCATION AND CREDENTIALS
Enter your graduation year as YYYY (eg. 1995)
If you answered no to the previous question, please provide the dates you attempted the examinations in mm/dd/yyyy format.
BCSRT Demographics
BCSRT DEMOGRAPHICS - All applicants and members are requested to provide the following demographics to assist the Association in developing statistical information on it’s membership. All information will be kept private and you will not be identified by name. Information will be disclosed to government offices for workload planning and for other uses as may be determined by the Board.
Major Areas of Practice Up to 3 Areas of Practice can be accommodated below - Primary; Secondary and Tertiary.
PERSONAL DECLARATION
DECLARATION AND UNDERTAKING

I declare that, to the best of my knowledge and belief, the statements made by me above are complete and accurate. I understand that non-compliance or misrepresentation of any section may be cause for revocation of my license and I undertake to notify the British Columbia Society of Respiratory Therapists, in writing, within 30 days of any change(s) in the information reported on this application.

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