Application for Membership

The Canadian Association of Child Neurology (CACN)  represents pediatric neurologists and those in pediatric neurology training across Canada.

As a member of the CACN, you are automatically a member of the Canadian Neurological Sciences Federation (CNSF).

Contact Information
First Name
Last Name
Position/Title
Hospital or Office/Business Address
Phone
Email
Home Address/Mailing Address
Phone
Email

Education/Professional Experience
Education Experience
Enter as 'Degree, Institution, Dates' - one line per entry
Add Line
Residency Training
Enter as 'Field, Institution, Dates' - one line per entry
Add Line
Fellowship Training
Enter as 'Field, Institution, Dates' - one line per entry
Add Line
Post Fellowship Plans
If currently in fellowship - indicate post-fellowship plans
Special Interests / Pediatric Neurology Experience

Provincial Royal College Medical License
Province of Licensure
Dates Valid

Membership Categories
Annual fee per calendar year - $475 (Canadian) Full Member applicants are physicians certified in Neurology (pediatric stream) by the Royal College of Physicians and Surgeons of Canada or licensed by the College of Physicians and Surgeons of any Province of Canada, or equivalent certification to practice pediatric neurology.
Year of residency PGY OR Fellowship year of
Program director's name
Annual fee per calendar year - $80 (Canadian). PGY1 residents receive complimentary membership. Junior Member applicants must be registered in a Canadian residency training program in pediatric neurology, or fellowship training in pediatric neurology, or in a related subspecialty fellowship, recognized by the Royal College of Physicians and Surgeons of Canada. Upon successful completion of a pediatric neurology training program and/or approved fellowship training, Junior members will be promoted to Full Member status.
Specialty / Field:
Annual fee per calendar year - $250 (Canadian) Associate Member applicants are MDs or PhDs, or other well-qualified workers in allied fields of medicine, who are interested in the study of the developing nervous system, but do not meet the requirements of Full membership.
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 this application. Unless you advise the secretariat office otherwise, we will use your contact information to disseminate CNSF, and CNSF Congress information, disseminate society information, and conduct society business. We do not loan, sell or rent our member lists.
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