Membership Checkout - Canadian Sleep Society (CSS)

Membership Information

You have selected the Organization/Corporation (not providing direct medical services) membership level.

(1 free membership - only 1 vote possible)
"Organization/corporate member" means a member organization, business or company related to the field of sleep medicine.

The price for membership is $5,000.00 per Year.

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Account Information

Username

Password

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Email Address

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Full Name LEAVE THIS BLANK

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More Information

NAME OR ORGANIZATION NAME

Org. address 1

Org. address 2

Org. city

Org. province

Org. country

Org. postal code

Org. phone

Org. website

Salutations

Degree(s)

Area(s) of interest

License Number

Proof of Certification

License Number

Proof of Certification

License Number

Proof of Certification

If Other, what is your profession.

License Number

Proof of Certification

Medical Director Name

License Number

Upload credentials in Sleep Medicine and provincial accreditation
by the Provincial College of Physicians and Surgeons or Hospital Accreditation.

Medical Director Name

License Number

Upload credentials in Sleep Medicine and provincial accreditation
by the Provincial College of Physicians and Surgeons or Hospital Accreditation.

Voting Right Member Name

Do you want to set up automatic renewals?

If you leave this box checked, your membership will automatically renew every year at $5,000.00 per Year.

Payment Information

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Expiration Date

CVC

Discount Code

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