Application for Medical Student Membership

First Name
Last Name
1. Canadian University or College of Medicine Name
Address
Phone
Email
2. Home Address/Mailing Address
Phone
Email
Supporting Documents
We require a signed letter from your Canadian University or College of Medicine which verifies your current standing within their undergraduate program. Please submit directly to donna-irvin@cnsf.org.
Anticipated MD completion (month, year)
Education/Professional Experience
Enter as 'Degree, Institution, Dates' - one line per entry
Add Line
Neurological Experience
Special Neurological Interests of Applicant

Medical Student Annual Membership Dues - $40.00/calendar year + gst

Medical Students that hold membership within the CNSF do not belong to one particular society of the Federation but globally to the CNSF. You will receive information relevant to all of the neuroscience specialties.

Our hope is that this information will assist in guiding you to your specific field of interest.
Protection of Privacy Information
The CNSF complies with the principles of the Personal Information Protection and Electronic Documents Act (PIPEDA). We will use the personal information collected on this form for processing your membership application. Once it is approved, unless you advise the secretariat office otherwise, we will use your contact information to: disseminate society information, conduct society business and include in the CNSF membership directory. We do not sell or rent our lists for financial gain. Other information provided on or with this form will be filed with the secretariat office.
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