Information Change


Please fill in the blank below a copy of the active Renewal or Information change form.
You can e-mail your info to, info@iccaom.net or fax to 1-416-352-6087(ext2). Mailing is still an option, but to speed up the process, it would be quicker to fax or e-mail this information.
The e-mail is secure as is the fax line.

Please fill out the information below:


 
1.Name: (first, given, designations):
2.Address:
3.City:
4.Province:
5.Postal code:
6.Nationality
7.Phone #
8.E-mail address: @

Active Registration number for Renewal.

IKSA:

IKSH:
OMP:
OMD:
Etc :


Would you like your name and information listed on the web member list YES NO

Note: We are extending the Renewal normal fee rate of US$40.00 until July 20, 2007. After that the fees will go to US$100.00 (late fee) plus a $10.00 web administration fee to have you name reinstated on the web site.

Fees:
Information Change. FREE
Active Renewal Fees. per item for three years US$40.00
Active Reissue Certificate (per term: $40 and delivery fee $40) US$80.00
Late Fees: If you pay later than deadline for your renewal, you should pay late fees.US$40.00
Fees included in payment:
Renewal Item: ACUPUNCTURE
HERBOLOGY OMP OMD BODYWORK
TOTAL

Visa or Master card # expiry date / Cheque: yes no

We will be updating our membership (practitioners) list on the web site. Please return this memo, as we will be using this information to up date the list. Insert information above, as you wish it to appear on the web site, including designations. Note we are limited in space per member. We will try to get all information on as best the space provides.

Memberships that have not been renewed by July 20, 2007, will be deleted from the web site until renewed. A reinstatement fee of US$50.00 will apply, to cover web administration costs.

Mailing address is ICCAOM, 141-6200 Mckay Ave, Suite557. Burnaby, BC.V5H4M9.Canada Voice 1-416-352-6087(ext1) Fax 1-416-352-6087(ext2) , 1-209-396-3453
Thanks you in advance for your prompt attention to this memo, S.Y. Kenneth


 

 

E-mail : info@iccaom.net   ¦¢  2018¨ÏICCA All right reserved