Application for Membership with MTAA
In following regulations pertaining to the Freedom of Information and Privacy Act, only a member's business contact information will be displayed and/or distributed. Personal information is used only for internal database purposes. In the event that a member's residential address is also their business address, it is understood and agreed by the member, as signed below, that this information may be given out by the MTAA for business purposes only.
In order to provide and improve member services the MTAA collects the personal and business related information contained in this application. Other than your name, city, province, membership number, membership status and the above-mentioned business contact information, information you provide on this form is confidential and will only be used for the provision of member services and statistical reporting in accordance with the Personal Information Privacy Act. All Active members understand that the collection, use and disclosure of personal information is done in accordance with this Policy and that business contact information and treatment types available in various formats as required from time to time, will be published in the "Find a Therapist" area of the MTAA Website for the public as well as for insurance provider verification purposes.
By submitting this application, the undersigned attests that this application has been completed accurately and honestly. No disciplinary action has been, or is pending, against you in any jurisdiction. You have never been the subject of any investigation either civil or criminal, in connection with any sexual act, conduct, molestation, and/or assault. You understand that your liability insurance certificate will provide evidence that you have been added as an individual participant with respect to the coverage and limits of the Master policy for Professional and General Liability Insurance. You understand that the coverage provided by the insurance certificate is subject to all the terms; conditions and exclusions contained in the Master policy. You further understand that the insurance company will rely on the information provided in this application. Providing false statements on this application or subsequent renewals shall void this application and render your insurance coverage null and void, and you may be subject to further legal action for making false statements.
By submitting this application, I declare that to the best of my knowledge the information provided and statements made in this application and any attached documents is true. I agree to abide by the MTAA Bylaws, Code of Ethics, Guidelines for Professional Boundaries, Standards of Practice and any other governing documents of the Association. I realize that I may lose my membership and membership privileges if complaints about me are found to be in violation of these documents. I further understand that membership dues are non-refundable in the event that I choose to cancel my membership at any time after application or renewal.
© Massage Therapist Association of Alberta