Name:*
Address:*
Telephone:*
-
E-mail:*
Select Specialty Examination 1:*
Select Specialty Examination 2:
Training Site:*
Training Site Other:
Application for Special Accommodations: (Applicants must complete and submit the Application for Special Accommodations to the Administrative Office)*

IN CASE OF AN EMERGENCY - If you would like us to contact someone on your behalf, please provide the following:

Emergency Contact Name:
Emergency Contact Telephone #:
-
Emergency Contact E-mail:

EXAMINATION FEES (due January 15, 2018)

  • General Written Examination ONLY: $700 CAD
  • Full Examination (General & Specialty Written/OSLEs): $2,000 CAD
  • Specialty Examination ONLY (Specialty Written/OSLEs): $1,300 CAD

Payments are accepted by cheque or money order payable to the CCMG and sent to: CCMG 4 Cataraqui Street Suite 310, Kingston, ON K7K 1Z7

Candidates sitting two (2) specialty examinations in the same examination cycle must submit an additional $1,300 (includes the Specialty Written and OSLEs).

A late registration fee of $300 will be applied to registrations submitted after January 15, 2018. Late applications will not be received after February 15.


Select the Examination Option: (1)

General Written Examination – Tuesday, May 22, 2018

Language of General Written Examination :

Specialty Written Examination - Friday, June 8, 2018

Language of Specialty Written Examination:

OSLEs – Saturday, June 9, 2018

Language of OSLEs:

Sitting 2nd Specialty Examination

Fee for sitting (2) two specialty examinations in the same examination cycle:

Late Fee (if applying after January 15 and before February 15)

Late fee: (Applications after February 15 will not be accepted.)

This confirms my intent to sit for the next cycle of CCMG examinations.

Signature:*
Date:*

THIS COMPLETED FORM WITH YOUR EXAMINATION FEE PAYMENT MUST BE RECEIVED BY THE CCMG OFFICE BY THE JANUARY 15, 2018 DEADLINE.
A $300 FEE MUST BE APPLIED TO REGISTRATIONS SUBMITTED AFTER JANUARY 15, 2018. 
APPLICATIONS RECEIVED AFTER FEBRUARY 15 WILL NOT BE ACCEPTED.


Total: