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Become a Member

The Canadian Association for Colon Therapy appreciates your interest in assisting our association and profession by supporting our endeavor.

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Canadian Association for Colon Therapy Application

Print form at bottom

Or Download Printable Application Here

Applicant Name

First Last

Phone

Address

Street Address Address Line 2 City Province Postal Code

Please answer the following questions (check applicable):

Are you currently working as a Colon Therapist Practitioner?

Yes

If YES, how long have you been practitioner?

Are you a colon hydrotherapy business owner?

Yes

Did you complete a certification program?

Yes

If YES, list name of school

Year Completed

What type of colon hydrotherapy equipment have you/do you use?

Do you have First Aid or CPR training:

Yes

If yes, please indicate the name of the school

If yes, please indicate date course completed

MM slash DD slash YYYY

Do you have any experience in any not-for-profit organizations?

Yes

If yes, please list

What was your role there?

Do you have any training on any other alternative health modalities?

Yes

If yes, please list the modality

If yes, please list name of school

Did you receive a diploma or certification?

If yes, please list date course completed

Please list any experience that might be a contribution to C-ACT

Please list the areas that you would be willing to donate your time in lieu of membership fee (first year only).

A paragraph stating why you are interested in membership with C-ACT?

Applicant’s Name (please print)

Date

MM slash DD slash YYYY

Applicant’s Signature:

This field is for validation purposes and should be left unchanged.

Or Download Printable Application Here

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416-291-4437

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info@canadianact.com

Canadian Association for Colon Therapists

c/o 346 Newkirk Road, Unit 9, Richmond Hill, Ontario, Canada

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