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

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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:*

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Contact Us

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Name*

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Email*

Comments*

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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