NaHSSA Registration

*= required

Registration Type :

Chapter

Committee/Council

Partner Organization

Other Organization

Individual Member

Autre :

Organization Name :

Organization Address :

Organization City :

Organization Province :

Organization Postal code :

Organization Country :

Would you like this organization to appear on the NaHSSA map? :

Oui

Non

Do you have a faculty advisor? :

Oui

Non

If the faculty is already a member, enter the username below and click "Confirm Faculty":

If the faculty is a new member, click on 'New Member' and fill out the new member registration form.

New Member

*Name of Faculty :

Please note this will be your member username.

*Password :

*Password Confirmation :

*Name of University/College/Organization/Employer :

Please input N/A, if not applicable.

*Health Science Profession :

Specialization :

*Email :

Address :

City :

*Province/State :

*Country :

Postal Code :

Would you like this faculty member to be added to the NaHSSA mailing list? :

Oui

Non

Would you like this faculty member to receive NaHSSA Announcements and Upcoming Events? :

Oui

Non

Would you like this faculty member to appear on the NaHSSA map? :

Oui

Non

Member Type :

CISN Member

Clinician

Other Individual Member

*Name of Member :

Please note this will be your member username.

*Password :

*Password Confirmation :

Existing Chapter/Committee/Council Member :

Other Chapter/Committee/Council Member :

*Name of University/College/Organization/Employer :

Please input N/A, if not applicable.

Profession :

Other Professions :