College of Medical Radiation and Imaging Professionals of Saskatchewan

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 CMRIPS.

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

I am ready to complete my application.

Education Category

Education Level

Program Start Date

Program End Date

Province

Country

Program Type

Program Start Date

Program End Date

Province

Country

Regulatory/Licensing Body

Country

Reg./License No.

Date Registration Held From

Date Registration Held To

From Date

To Date

Employer Name (name of facility)

Workplace Community (i.e. City/Town)

*Please request a CFTA Transfer Form from your current regulator

Country

Province

Postal Code

Address

Phone

Fax

Employer Type

Division / Site

Department

Are you engaged in clinical education / preceptor activity? Yes No

Employer Name (name of facility)

Workplace Community (i.e. City/Town)

*Please request a CFTA Transfer Form from your current regulator

Proposed Start Date

Employer Name (name of facility)

Country

Province

Workplace Community (i.e. City/Town)

Fee Schedule

Initial Application Fee:

Please select an class of registration in the Registration Details section above.
Practicing: $125.00
Student: N/A
Retired: $125.00
Associate: $125.00
Graduate: $125.00
Temporary Registration for DMS: $125.00

CMRIPS Registration Fee:

Please select an class of registration in the Registration Details section above.

Student: $125.00
Retired: $30.00
Associate: $155.00
Graduate: $190.00
Temporary Registration for DMS: $445.00

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.

I certify that I am of good character and will practice the profession of medical radiation and imaging 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 and Imaging Professionals Act and the Bylaws of the College of Medical Radiation and Imaging Professionals of Saskatchewan (CMRIPS) and to notify the college 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 CMRIPS Council to verify the statements made and information provided by me. - I so declare and agree

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Initial Registration Application

Instructions

General Requirements