AQTN's Online Application Process

Once you submit this form, you will receive an email confirmation.
Your payment can then be made by Credit Card, Cheque, e-Interac or Paypal.




First Name:


Last Name:


Date of Birth: (YYYY-MM-DD)


Male Female

Language(s) Spoken:


Correspondance address
This is where will mail your welcoming kit and receipts.


Address:


City:


Postal Code:


Region:


Province:


Phone number to appear on your receipts:


Other telephone: (leave blank if none)


Facebook profile: (leave blank if none)


Email:


Website: (leave blank if none)

Your website, a blog, your LinkedIn, a directory listing - any online presence.

Are you currently, or have you ever been an active member of any other association?
Yes No

Yes? Please specify which:


Designation sought:

Massotherapy / Orthotherapy / Kinesitherapy
Naturopathy
Naturotherapy

Check this box if you do not have a printer and we will mail you the form.


Once you click Submit application, you will receive an automated email to confirm your email address, validate your mailing address and to process the payment if paying online. There will also be instructions for sending in the other required documents.

Because we require an actual signature, the process cannot be entirely done with an online form.