Saskatchewan College of Respiratory Therapists - IERT Registrant Subscription Personal Info

SCRT PRIVACY STATEMENT

2.0 PERSONAL IDENTITY

Provide your full legal first, last and middle names. Do not use initials, nicknames or diminutives such as "Deb" or "Al" unless it is your legal given name. NOTE - How you enter your name here is how it will appear in the official SCRT register, so be sure to use proper case. Once entered, your name may be locked and only changed by making official application to the college to amend the SCRT register.

Honorific *

First Name *

Last Name *

Middle Name

Provide any other surname(s) by which you have been known, or that may appear on your education or certification credentials (eg. a maiden name). If more than one, separate each name by a comma (eg. Smith, Brown). If you have not been known by any previous surname(s), leave this field empty.

Previous Surname(s)

Enter your birthdate, gender and first language in the spaces provided below. NOTE that once entered, these fields cannot be changed without contacting the SCRT office.

Date of Birth (mm/dd/yyyy) *

Gender *

PRIMARY CONTACT INFORMATION - Please provide your primary contact information below.

Primary Address

Address Line 1 *

Address Line 2

City *

Country *

Province/State *

Province/State

Postal/Zip *

Your primary email address is the address to which all official SCRT email communication will be directed.

Primary Email *

Please enter your primary phone number. If you do not have a primary land line but use a cell phone instead, enter your cell phone number here.

Primary Phone No *

Cell Phone

If you'd like SCRT email to be directed to a second email address in addition to the primary email address provided above, enter it here.

IT IS IMPORTANT TO REMEMBER THAT UNLESS YOU SPECIFY A SECONDARY EMAIL ADDRESS HERE, OUR PASSWORD RETRIEVAL SYSTEM WILL SEND YOUR PASSWORD TO YOUR PRIMARY EMAIL ADDRESS ONLY. A secondary email address can be helpful should your primary email account become inaccessible for some reason (mailbox full, for example).

Secondary Email

Login Information - create or edit your login credentials

Username *

Password *

Password Confirmation *