M E M B E R S H I P
Application

of the Ontario Society of Diagnostic Medical Sonographers


Surname :

First Name:

Credentials:

Province:

Address :

City:

P.C.:

Registry Numbers's (If Applicable)

Membership Categories: (explained below)

Active ($60.00)

Associate ($60.00)

Student

ARDMS :

CARDUP:

Registered Specialties:

Abd Ob/Gyn Neuro Breast Adult Echo Ped Echo Vascular Ophthalm

I authorize OSDMS to charge my Visa card as noted below for the amount of :

Amount: $

Name:

as printed on card

Visa
credit card
only

Visa Number:

Expiry Date

Month / Year

Signature:
___________________________________

If Mailing your application -
Please fill in the form above, print and forward with appropriate fee as a Visa entry, cheque, money order or certified cheque to:
 Executive Director OSDMS,
P.O. Box 188
Oakville, Ontario
L6J 5A2

If Faxing your application -
Please fill in the form above, print and fax
(for Visa credit card users only) to:
905-849-0653

THANK YOU

M E M B E R S H I P
C A T E G O R I E S

 

ACTIVE MEMBER: One who has

ASSOCIATE MEMBER: Members who have

HONORARY MEMBERS: members who the

INACTIVE MEMBERS: former active members

STUDENT MEMBERS: members who are