Member's Only Area
User ID:

Password:

Forgotten Password | Join CST

Canadian Society of Transplantation
774 promenade Echo Drive, Ottawa, ON K1S 5N8
TEL: 613-730-6274 FAX: 613-730-1116
www.cst-transplant.ca Email: cst@royalcollege.ca

Application for CST Membership


    NEW MEMBER APPLICATION FORM


  1. SELECT APPLICABLE OPTION(S): required

    Full Member Associate Member Trainee/Fellow Corporate Member
    $150.00
    		 $25.00
    		$25.00 $200.00

    Additional Joint TTS Membership - Please select if desired:
    Full Member Associate Member Trainee/Fellow
    $50.00
    		 $25.00
    		 $25.00 None


  2. PLEASE COMPLETE CONTACT INFORMATION BELOW:

    Title: required
    First Name: required
    Last Name: required
    Gender: required Male   Female
    Company/Inst.:
    Do you want this added to your mailing address? YES
    Department:
    Street: required
    City: required
    Province/State: required
    Postal Code/Zip: required
    Country: required
    Phone: required
    Fax:
    Email: required
    Verify Email: required
    Language: required English    French


  3. PROFESSIONAL DESIGNATIONS required

    MD    MSc    PhD    FRCPC    FRCSC    Other     None   

    Year that you started professional practice:


  4. PLEASE CHECK APPLICABLE DISCIPLINE: required

    Anaesthesiologist
    Biochemist
    Clinical Educator
    Dietitian
    Infectious Diseases
    Immunologist
    Intensivist
    Laboratory technician (Clinical Lab)
    Laboratory technician (ReseachLab)
    Manager - Administrator
    Microbiologist
    Occupational Therapist
    Organ Procurement & Preservation
    Pathologist
    Perfusionist
    Pharmacist
    Psychologist
    Physiologist
    Physiotherapist
    Registered Nurse
    Research Scientist
    Respiratory Therapist
             Technologist
             Others
    Social Worker
    Trainee
    Transplant Coordinator
    Transplant Physician
    Transplant Surgeon
    Other (please specify below)   

    What best describes your primary practice environment: required

    Private practice
    Hospital; academic/University-affiliated health center
    Hospital; unaffiliated
    Regional / provincial / national agents:
    Other:   

    Primary clinical transplantation practice specialization: required

    Adults
    Heart
    HLA
    ID
    Kidney
    Liver
    Lung
    Pancreas
    Pediatric
    Other:   


    Primary laboratory transplantation service specialization: required

    Biochemistry
    Histopathology
    Immunology
    Microbiology
    Not Applicable


    Please check applicable practice / work areas / principal area(s) of interest: (CHECK ALL THAT APPLY)

    Bio Artificial Cells and Organs
    Bone Marrow
    Cell Transplantation
    Ethics, Economics & Quality of Life
    Experimental Transplantation
    Histocompatibility and Immunogenetics
    Immunobiology
    Immunosuppression - Experimental
    Infections
    Intestine
    Islets
    		Organ Procurement & Preservation
    Transplantation in Developing Countries
    Xenotransplantation
    Other (please specify below)



  5. Percentage of time spent on: required

    Percentage Time (Research):
    Percentage Time (Education):
    Percentage Time (Clinical):
    Percentage Time (Administration):


  6. PLEASE CHECK APPLICABLE TRAINING: (OPTIONAL)

    Provide list as follows:
         1. Formal training: Degree/University/year (list each one);
         2. Post-graduate (post-fellowship) training: Site/clinical or research/year completed;
         3. Professional certification: type, year received.
         4. University appointments: University, rank, first year

    Degree:    Other     

    Discipline or Specialty:   
    University/Institution:   
    Year completed:


    Degree:    Other     

    Discipline or Specialty:   
    University/Institution:   
    Year completed:


    CLICK HERE TO ADD MORE EDUCATION



    Specialty Certification:

       Other

    Specialty:   Year of completion:



    CLICK HERE TO ADD MORE SPECIALITIES





  7. Current academic appointment: (OPTIONAL)

    University or academic appointment: Yes No

    Academic rank:        
    Name of University:

  8. CST Group memberships:

    If you wish to become a member of any of the following CST groups, please indicate your interest. Your application will be processed by the relevant CST group and you will receive separate confirmation of your membership status. (OPTIONAL)

    Allied Health (Formerly known as "Associate Members Group")
    Heart
    Donation
    HLA
    Kidney
    Liver
    Lung
    Pancreas
    Pediatric
    Pharmacy
    CST Board


  9. CST Committees:

    I am interested in being considered for the following committees. (OPTIONAL)

    Scientific Meetings Committee
    Education Committee
    Ethics Committee
    Grants & Awards Committee
    Nominations Committee
    Public Policy Committee
    Research Committee
    Standards Committee
    Communications Committee
    Finance Committee
    RC Certification Committee


Thank you for joining the Canadian Society of Transplantation.

Once you click on the 'SUBMIT' button, you will be directed to the CST Dues payment page.

Please fill out all your information and click on 'SUBMIT'.

In the 'Member ID' field, please insert '999999'.

Merci pour votre application à la Société canadienne de transplantation.

En cliquant sur le bouton 'Veuillez soumettre' vous serez dirigé à la page de 'Cotisation annuelle'.

SVP fournir l'information requise et cliquer sur le bouton 'Veuillez soumettre'.

Pour le numéro de d'identification, veuillez indiquer '999999'.







The CST is committed to improving communications with its members. Please provide comments or suggestions to improve this form or the website.

FEEDBACK