IEMLT- Temporary Practicing Application Subscription Personal Info - SSMLT | Saskatchewan Society of Medical Laboratory Technologists

IEMLT- Temporary Practicing Application Personal Info

Personal Information

Last Name *

First Name *

Middle Name

Preferred Name

Former Last Name

Gender *

DOB *

Address

Address Line 1 *

Address Line 2

City *

Country *

Province/State *

Province/State

Postal/Zip *

Primary Phone *

Available with Canadian mobile phone numbers only, to be used to send important member information. To receive sms/text messages, you must enter your mobile phone number Format +1 (area code) 7 digit local number

Mobile Phone Number

Fax

Work Phone

Work Extension

Primary Email *

SSMLT communicates with Members via email. The Primary e-mail is the Email used to correspond with you

Alternate Email

Username *

Password *

Password Confirmation *