The British Columbia Society of Respiratory Therapists (BCSRT)

APPLICANTS IDENTIFICATION

Gender

BCSRT Member #
(if applicable):

Title:

Surname:

Usual first name:

Middle Initials:

Maiden or
Previous Surname
(if applicable):

Date of Birth:

	/		/
MM	/	DD	/	YEAR

Application Type:

New Renewal Reinstatement

Membership Applied For:

Registered $85
Associate $20
Corporate $75
Student $15

Permanent Mailing Address
( #, street, R.R#,.P.O.Box#):

City/Town:

Province:

Postal Code:

Home Phone:

( ) - -

Bus. Phone:

( ) - - Ext.:

E-mail:

EDUCATION

Name / Location of Institution Attended for Respiratory Therapy Training:

Date Graduated:

	/		/
MM	/	DD	/	YEAR

VERIFICATION OF SUCCESSFUL COMPLETION OF APPROVED EXAMINATION IN RESPIRATORY THERAPY

Are you a new graduate?

Yes No

Eligible to write?

Yes No

Exam Complete?

Yes No

CSRT Registry # (if completed):

RECORD OF EMPLOYMENT OVER THE PAST 12 MONTHS

Employer:

Address:

Postal Code:

Telephone:

( ) - - Ext.:

Start Date:

Classification:

Full Time Part Time Casual

Approx # Hours Worked per week:

Employer:

Address:

Postal Code:

Telephone:

( ) - - Ext.:

Start Date:

Classification

Full Time Part Time Casual

Approx # Hours Worked per week:

ADDITIONAL COMMENTS

Please Let Us Know About Any Other Significant Information:

DECLARATION

Article II � Membership B.C.S.R.T. Constitution and By-laws



1. Membership in the Society shall be divided into the following categories:

a.) Active membership;

b.) Associate membership;

c.) 3rd Year Student membership;

d.) 1st and 2nd Year Student membership;

e.) Honorary membership;

f.) Corporate membership.



2. All members shall comply with the Constitution and Bylaws of the Society and all decisions, rulings, or orders made pursuant thereto by  he Board of Directors, the Executive Committee, the Professional Conduct Committee, or any officer or other committee of the Society.



3. All amounts owing to the Society by a member or former member whether as dues, assessments, levies, costs, penalties, fines, or otherwise, constitute a debt due from the member or former member to the Society and are recoverable as such by action brought by the Society against the member or former member in any court of competent judgement.



4. A person shall cease to be a member of the Society:

(a.) on delivering his resignation in writing to the secretary, provided that no resignation is effective until accepted by the Board of Directors and no resignation shall relieve or release the person from any duties, liabilities, or responsibility as a member that existed prior to the date of acceptance of his resignation;

(b.) on his death;

(c.) on being expelled as provided by these By-laws; or

(d.) on having been a member not in good standing for one month on account of non-payment of annual dues and the Board of Directors thereafter summarily and without a hearing resolving to expel him.



5. All members are in good standing except:

(a.) a member who has failed to pay his annual dues or any other amount owing by him to the Society;

and

(b.) a member whose membership is suspended as provided by these By-laws.



6. During the period that a member is not in good standing, he shall not be entitled to any of the rights, privileges, or benefits of membership and in particular, he shall not be entitled:

(a.) to receive notice of or to vote or attend at general meetings of the Society,

(b.) to stand for election or serve as a director or officer or to be appointed to any committee of the Society, and

(c.) to use the title "Registered Respiratory Therapist" or the initials "R.R.T.", but, such a member remains, nevertheless, subject to all the duties and obligations of a member as though he were a member in good standing.







Article IX � Annual Dues B.C.S.R.T. Constitution and By-laws



1. The annual dues payable by members shall be determined from time to time by ordinary resolution passed by the members, present in person, at an Annual General Meeting. Proxies may not be used for voting purposes on any resolution to determine annual dues. Editorial Comment (This means that a simple majority of the ~ 16 members present at the 1999 AGM could have determined the dues payable for the 2000 fiscal year).



2. Annual dues may be determined at different amounts for different categories of membership.



3. Annual dues for a fiscal year shall be payable on or before the 31st day of March of the preceding fiscal year.



4. Failure by a member to pay annual dues when due will result in his membership ceasing to be (held) in good standing and renders her subject to summary expulsion from membership as provided in Section 4(d) of Article II of these By-laws.



5. Any person expelled from membership for failure to pay annual dues may, at the discretion of the Board of Directors, be reinstated to membership if he applies for reinstatement and tenders payment of his accrued arrears of annual dues and payment of a reinstatement fee as may be set by the Board of Directors in an amount not to exceed the amount of the accrued arrears of annual dues owing.

I have read, understood, and agreed to the above Articles.

I authorize the (C.B.R.C.) Canadian Board of Respiratory Care to release my examination results
(pass/fail) to the B.C.S.R.T. for the sole purpose of determining eligibility for B.C.S.R.T. registration.

Have you ever been disciplined by, or are you currently being investigated by any Body responsible
for the regulation of this or any other profession?
Yes No

In applying for membership of the British Columbia Society of Respiratory Therapists, I hereby acknowledge that I have an obligation to observe, respect and uphold the principles, rules and standards of conduct as set forth in the Constitution and By-laws and Code of Ethics of this Society.

Plese select payment method:

I want to pay online using my VISA or Mastercard credit card
I am sending a cheque
I paid BCSRT dues via the CSRT