Join the CDA - Full Member Application

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Personal Information

Pronouns

Salutation *

First Name *

Last name *

Date of Birth *

Direct Phone

E-mail *

Secondary Email

Preferred language of correspondence *

English

French

Email Opt-In *

I hereby consent to receive information and materials from CDA via email or other electronic communication means. This includes, but is not limited to, eBulletins, member updates, surveys, event packages, and networking opportunities. I understand that I can unsubscribe from receiving these communications at any time.

Password *

Password must be a minimum of 8 characters long and contain at least 1 uppercase letter, 1 lowercase letter and 1 number.

Password

Confirm password

Your Offices & Addresses

Please include below your preferred address(es) for mailing, billing and inclusion in our Find-a-Dermatologist public directory.

Are you affiliated with a Canadian university?

Yes

Primary Clinic / Practice

Clinic Name
If you do not find your clinic listed, please select ‘Create New Company’ to input the details. *

Existing Office

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Create New Office

URL

Telephone

Fax

Address line 1

Address line 2

City

Province

Postal Code

Country

Add a personalized room or suite number to this address

Please indicate if this is your mailing and/or billing address

Mailing

Billing

Would you like to have another clinic / practice added to the public Find a Dermatologist directory?

Alternative Address(es)

Would you like to provide an alternative address (i.e. home) for mailing and/or billing?

I would like to add an additional mailing and/or billing address

Education Information

Medical School

Was your medical school at a Canadian institution?

Yes No

Institution

Year graduated

Do you want to add an additional medical school?

Dermatology Residency

Was your residency at a Canadian institution?

Yes No

Institution

Start Date

End Date

Do you want to add an additional residency?

Fellowship

Was your fellowship at a Canadian institution?

Yes No

Institution

Degree Specialization

Date Obtained

Do you want to add an additional fellowship?

Other Universities and Degrees

Was this other education at a Canadian institution?

Yes No

Institution

Degree

Degree Specialization

Year Obtained

Do you want to add another degree?

Dermatology Certification

Were you certified by the Royal College of Physicians and Surgeons of Canada? *

Yes

Were you certified by the American Board of Dermatology? *

Yes

Were you certified by another board? *

Yes

Getting to Know You

Membership Outside of CDA

Practice Location *

Practice Focus *

Languages Spoken *

Are you willing to speak to media? *

Yes

Terms & Conditions / Privacy Policy

Agreement to Abide by By-law

I agree that, should my application for membership be approved, that I will abide by the BY-LAW governing the conduct of affairs of the Canadian Dermatology Association (CDA). Click here to access the By-Law.

Purchases

By completing a purchase with the Canadian Dermatology Association (CDA), you agree to have your credit card and personal information securely stored as part of a payment profile within a 3rd party payment gateway. This securely stored payment profile will be used, when authorized, for automated recurring payments. No credit card information is stored within the CDA’s system (Association DNA), and all payment data is accessed by way of a secure API. Under no circumstances will CDA share credit card or personal details.

CDA members are automatically enrolled in Automatic Recurring Billing (ARB) to facilitate the payment of annual membership dues. Members are able to opt out of ARB in several ways:

Via the Members’ Portal at any time throughout the year

By emailing us at members@dermatology.ca

By following the instructions in an email sent one month prior to annual membership dues renewal

Privacy

The CDA is committed to maintaining the privacy of the personally identifiable information of our members. Our policies are designed to disclose how the information collected will be used.

Personal information may be used internally for activities including, but not limited to: maintaining member records, providing member services, providing certificates of attendance for events, sending communications, responding to member and other stakeholder inquiries, and for marketing purposes for CDA and CDA partners alerting members of additional services available. We may also use personal information as otherwise permitted or required by law.

Aggregated or other non-personal information may be shared (i.e. information about you and other members collectively, but not specifically identifiable to you) with third parties. For example, we may tell our advertisers the number of visitors to our website and the most popular features or services accessed. This information does not contain any personal information and may be used to develop website content and services that we hope you and other users will find of interest and to more appropriately target content and advertising.

Special Categories of Data

Racial/ethnic origin and gender are both considered to be a “special category of personal data” and may be collected by us in order to carry out legitimate activities as a non-profit entity. This data will only ever be used in aggregate, and will never be specifically identifiable to you.

* I agree to the terms and conditions.

Pre-Authorized Dues Renewal *

I consent to be billed on an annual basis for my CDA membership dues. I understand that I can opt-out at any time

$ 425.00 - Member Dues

Join the CDA - Full Member Application

Personal Information

Password *

Your Offices & Addresses

Primary Clinic / Practice

Second Clinic / Practice

Alternative Address(es)

Additional Personal Address

Education Information

Medical School

Additional Medical School

Dermatology Residency

Fellowship

Other Universities and Degrees

Dermatology Certification

Getting to Know You

Terms & Conditions / Privacy Policy