Membership Application

Member Profile - Extended

1.0 Profile

Name
Name
First
Last

1.1 Home Address

Address *
Address
City
State/Province
Zip/Postal
Country

1.2 Mailing Address

Same as Home Address
Address *
Address
City
State/Province
Zip/Postal
Country

2.0 Designations

2.1 Designations

2.2 Designations - Certifying Auditor

I intend to or am currently working towards a designation listed in section 2.0.
List all that apply

3.0 Education

Completed?
Actual Or Anticipated

4.0 Employment

5.0 Declarations

Are you a resident of Alberta?
Have you ever had a finding of unprofessional conduct or similar finding made against you by any professional organization?
If yes, please provide further information.
Do you have any outstanding complaints or discipline matters with any professional organization with which you have been registered?
If yes, please provide further information.
Have you even been convicted of a criminal offence in any country?
If yes, please provide further information.
Have you even been found guilty of a breach of a university or similar code of conduct, or an academic infraction of any post-secondary education institution?
If yes, please provide further information.
I hereby consent to have the following contact information publicly posted on the ASHSP website, check all that apply (membership number and category will be displayed with applicable selections below):