BCSRT Applicant Personal Info
PRIMARY CONTACT INFORMATION Please provide your primary contact information and indicate the type of information it represents (Home or Work).
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 answered no to the previous question, please provide the dates you attempted the examinations in mm/dd/yyyy format.
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.
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.