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Saskatchewan Association of Medical Radiation Technologists SAMRT

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Initial Registration Application

Instructions

General Requirements

Complete this application in full
Pay all applicable fees (see fee schedule on the application form to follow)

Registrants are expected to keep their file current while registered with the SAMRT.

If you are an Internationally Educated MRT please proceed with the IEMRT application.

I am ready to complete my application.

Create Your Account

You must enter an email address that you monitor regularly. All correspondence from SAMRT will be sent via email. This email address will also serve as your username.

Password

Your password must be at least 8 characters long and contain 3 of the following 4 criteria:
an upper-case letter, a lower-case letter, a number, a symbol.

Confirm Password

Confirm Password must match Password exactly.

Registration Details

Discipline

Secondary Discipline (optional)

Class of Registration

Practicing: Has met basic requirements of the profession and is able to practise in the profession in Saskatchewan.

Student: Registered as an MRT student in Saskatchewan.

Retired: Has retired from practising in the profession in Saskatchewan.

Associate: Practising with a limited skill-set in Saskatchewan.

Graduate: New graduate, not yet licensed in Saskatchewan.

Members Data

First Name

Middle Name

Last Name

First Name Used in Practice

Previous Name

Country

Province

Postal Code

City

Address

Address Line 2

Secondary Email

Home Phone

Mobile Phone

Fax

Date of Birth

Gender

CAMRT #

Basic MRT Education

Institution

Education Category

Education Level

Program Start Date

Program End Date

Province

Country

Other Education

Institution

Field of Study

Program Type

Program Start Date

Program End Date

Province

Country

National Exam

Have you written the national exam?

Yes

Date Written

Professional Registrations (other than SAMRT)
Please complete the attached Registration/Licensure Data Verification Form to support your status or registration with a regulatory/licensing organization other than the SAMRT.

Regulatory/Licensing Body

Country

Reg./License No.

Date Registration Held From

Date Registration Held To

Pending Employment

Proposed Start Date

Employer Name (name of facility)

Country

Province

Workplace Community (i.e. City/Town)

Payment of Fees

Fee Schedule

Initial Application Fee:

Please select an class of registration in the Registration Details section above.
Practicing: $120.00
Student: N/A
Retired: $120.00
Associate: $120.00
Graduate: $120.00

SAMRT Registration Fee:

Please select an class of registration in the Registration Details section above.
Practicing: $425.00
Student: $120.00
Retired: $30.00
Associate: $155.00
Graduate: $180.00

Payment Method

Choose Your Method of Payment

Credit Card

Upon submission, you will be asked to provide credit card information. Visa MasterCard American Express

Upon submission, you will be given mailing details.

Upon submission, you will be given instructions on where to send your e-Transfer.

Declarations and Undertakings

I certify that I am of good character and will practice the profession of medical radiation technology with decency, honesty and integrity and that I have no personality or character trait or disability that could affect my ability to practice the profession safely. I further declare that the statements made by me in this application and contained in any documents relating to this application and provided by me or at my request are complete and accurate. I acknowledge and understand that any false or misleading statement, representation or declaration in or in connection with my application, whether by commission or omission, may be cause for revocation of my registration. I undertake to adhere to The Medical Radiation Technologists Act, 2006 and the Bylaws of the Saskatchewan Association of Medical Radiation Technologists (SAMRT) and to notify the association within 30 days of any material change(s) to the information reported by me in this application, and I hereby grant permission to the release of any membership information as approved by the SAMRT Council to verify the statements made and information provided by me. - I so declare and agree