Form – British Columbia Association of Osteopathic Manual Practitioners

Membership Application

BCAOMP

1505-450 Westview Street

Coquitlam, BC V3K 0G3

Phone: (672) 886-1214

Email : osteofiore@gmail.com

Website : http://www.bcaomp.com

Application Information

Name of College :

Address:

Attended from :

Did you graduate :

Yes No

Degree / Diploma :

Other education :

Reference :

Full name :

Company :

Address :

Relationship :

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Have you been convicted of a criminal offense?

Yes No

If yes, type of offense :

I certify ____________________________that my answers are true and complete to the best of my knowledge.

Signature :

Date :

British Columbia Association of Osteopaths Manual Practitioners (BCAOMP) is a voluntary self-governing body, established by the manual osteopathy profession in British Columbia.

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