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!!!!International Organization of Nutritional Consultants
115 George St., Suite 513, Oakville, ON, CA L6J 0A2 Phone: 905-815-9282 · Toll Free: 1-866-540-1114 · Fax: 905-815-9731 · [email protected] !
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I.O.N.C. – 2014-2015- IONC PROFESSIONAL MEMBER APPLICATION Please complete this form and return with payment to:
I.O.N.C. 115 George St., Suite 513
Oakville ON L6J 0A2 or fax 905 815 9731
Name:_______________________________________
This checklist
A completed application form for Professional Membership 2014 - 2015
A signed and dated copy of the IONC PROFESSIONAL MEMBER Pledge
One passport sized photo
Copies of FINAL transcript, photocopies of certificate and any other documentation of your training qualifications
A cover letter stating why you wish to become an IONC Professional member
A letter from each of two professional people – lawyer, accountant, teacher, minister, doctor, nurse, chiropractor, manager etc. – who would be willing to give you a charac-ter reference
A resume that may support your application
A signed and dated copy of the I.O.N.C. Privacy policy
!!!!International Organization of Nutritional Consultants
115 George St., Suite 513, Oakville, ON, CA L6J 0A2 Phone: 905-815-9282 · Toll Free: 1-866-540-1114 · Fax: 905-815-9731 · [email protected] !
Application membership fee payable by Visa, MasterCard, cheque or money order payable to I.O.N.C. !Fees !Please note Ontario residents are required to pay a supplemental fee of $50.00 to support our joint government regulation submission.
$375 + $50.00 + HST 13% = $ 480.25 ONT $375 + HST 13% = $ 423.75 NB $375 + HST 14% = $ 427.50 PE $375 + HST 15% = $ 431.25 NS $375 + GST 5% = $ 393.75 AB BC QC MB NL SK NT NU YT International applicants $375.00 in Canadian funds !
Our membership year runs from April 1 to March 31 !If your application is received September1st –Jan 31st your base fee will be REDUCED to $190.00+ tax to reflect our membership year. !
$190 + $50.00 +HST 13% = $ 271.20 ONT $190 +HST 13% = $ 214.70 NL NB $190 +HST 14% = $ 216.60 PE $190 +HST 15% = $ 218.50 NS $190 +GST 5% = $ 199.50 AB BC SK QC MB NT NU YT International applicants $190.00 in Canadian funds. !
Applications received Jan 31 st –Feb 28 th will have their membership extended into the next membership year. !!
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!!!!International Organization of Nutritional Consultants
115 George St., Suite 513, Oakville, ON, CA L6J 0A2 Phone: 905-815-9282 · Toll Free: 1-866-540-1114 · Fax: 905-815-9731 · [email protected] !
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PROFESSIONAL MEMBERSHIP 2014-2015- APPLICANT INFORMATION
Name: Date of Birth:
Print Name clearly below as you would like it to appear on your certificate (no credentials allowed): !Mailing address:
City: Province: Postal Code:
Home Phone: Business Phone:
Email:
EDUCATIONAL INFORMATION
University/College Name of School(s) Year
Continuing Education List nutrition related class-room courses completed
Name of institution Certificate/Diploma Date
FEES – PROFESSIONAL MEMBERSHIP (ROHP/RNCP)/(OHP/NCP)
New Members
$375 +$50.00 + HST 13% = $480.25 (Ontario ) $375 + applicable HST (non Ontario residents please see pricing table on check list)
$
!!!!International Organization of Nutritional Consultants
115 George St., Suite 513, Oakville, ON, CA L6J 0A2 Phone: 905-815-9282 · Toll Free: 1-866-540-1114 · Fax: 905-815-9731 · [email protected] !
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PROFESSIONAL LIABILITY INSURANCE – MANDATORY On acceptance for membership, you can to apply for our group rate insurance forms available under’ How to join”
PARTNERS INDEMNITY
Please complete the appropriate insurance application on our website and return it directly to Partners Indemnity with a cheque payable to Partners Indemnity Insurance brokers.
10 Adelaide Street East, Suite 400
Toronto ON M5C 1J3
OTHER INSURANCE
I will not be purchasing liability insurance through I.O.N.C. as I am already insured by:
Insurance Co.: Policy #:
Signature: Dated on:
I.O.N.C. PROFESSIONAL LIABILITY WAIVER – IF REQUIRED Sign this section if applicable to you
I request to be exempt from purchasing professional liability insurance as I will not be practicing between April 1 2014, and March 31, 2015, will not be seeing any clients nor charging for appointments and there-fore, I understand that if I breach this agreement I will automatically lose my Professional Membership designation and my Membership with I.O.N.C. will be terminated and will not be reinstated.
Signature: Dated on:
THE IONC PRIVACY POLICY
The federal Personal Protection and Electronic Documents act came into its broadest effect on January 1, 2004; the I.O.N.C. is subject to stringent guidelines regarding the collection, storage and disclosure of private and personal information we gather. !Please read the I.O.N.C. Privacy Policy included with this new application form package and sign the dec-laration below:
!I,___________________________________________________, Have read the I.O.N.C. Privacy Policy and I understand it.
Signature: Dated on:
!!!!International Organization of Nutritional Consultants
115 George St., Suite 513, Oakville, ON, CA L6J 0A2 Phone: 905-815-9282 · Toll Free: 1-866-540-1114 · Fax: 905-815-9731 · [email protected] !
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CUSTOM DIRECTORY LISTING REQUIRED Your directory listing on the I.O.N.C. website will be your contact details unless you notify us below:
Name: Home Phone:
Business Name: Business Phone:
Address: City:
Email: Province: !Postal Code:
Website:My practice specializes in…
DONATION Amount donated will be included in your receipt
I would like to make the following donation to help support I.O.N.C., which is a non profit organization. $
PAYMENT INFORMATION Please fill appropriate amount and payment method
Total Fee: $ Visa MasterCard Cheque
Credit Card #: Expiry Date:
Credit card Signature: 3 digit security code# !
