Membership Checkout - CAMAP | ACEPA

Membership Information

You have selected the Regular New - Dynamic Fields membership level.

The price for membership is $195.00 per Year.

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Account Information

Username

Password

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Note: Your password must be at least 8 characters long and contain upper and lowercase letters, a number, and a special character.

First Name

Last Name

Email Address

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Membership reference

For new members only:

In order to ensure a safe and respectful online community, CAMAP requires that new members provide a reference who can attest to their current or future involvement in MAiD-related activities. This includes, but is not limited to, a current or former member of CAMAP, an administrator or manager within your MAiD community, or a MAiD or medical program director/health authority administrator who grants MAiD-related privileges. Please enter your reference's email address here; they will receive an automated email requesting verification of your status.

Please do not enter your own email address.

Only valid email addresses will be accepted. Do not include the name of your reference plus their email.

Billing Address

First Name

Last Name

Address 1

Address 2

City

Province

Postal Code

Country

Phone

Payment Information

Card Number

Expiration Date

CVC

Discount Code

I agree to the Membership agreement

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