Changing to Associate

If you are currently a regulated member and are leaving practice, you may stay in contact with the College while you are away by becoming an associate member. Please provide the College with the following information.

Last name *

First name *

Registration number *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone number *

Registration Change

Reason for change *

Effective date *

Declarations

You may be contacted by the College for further information.

I understand that I must hold a provisional or general practice permit with the College in order to practice the profession of denturism in Alberta. *

I understand that the practice of denturism is not restricted to only providing direct patient services, but also includes the design, construction, repair, alteration and fitting of any complete or partial denture for the purpose of restoring and maintaining function and appearance; teaching, managing or conducting research in the science, techniques and practice of denturism; or providing restricted activities authorized by the Denturists Profession Regulation. *

I understand that I may not use the protected titles of denturist or registered denturist once I am no longer regulated by the College. *

I acknowledge that I am responsible for compliance with the Continuing Competence Program for the time that I was a regulated member with the College of Alberta Denturists. *

I understand that the qualifications for eligibility for registration as a regulated member may change in the future without notice. *

I understand that it is unlawful to practice denturism in Alberta without being registered with the College of Alberta Denturists and that penalties may be enforced, as per the Health Professions Act, should I act unlawfully in this manner. *

I understand that as per section 48(1) of the Health Professions Act, a person who meets the requirements of s. 46(1) [mandatory registration] and does not comply with a request to register with the College under s. 46(2) is guilty of an offense. *

I understand that for two years, following my change to unregulated status, a complaint may be lodged against me through the legislated complaint process. *

I understand that the collection, use and disclosure of my personal information will be handled in accordance with applicable privacy policies and laws. *

I will immediately advise the College, in writing, if there is any change to any of the information contained in this application. *

I will immediately advise the College, in writing, should I wish to return to practice. *

I verify that all information contained in this application, including these declarations, is complete and accurate. I understand that a false or misleading statement, an omission or misrepresentation may have impact on my future registration as a denturist in Alberta. *

Phone