Canada's National Association

Committed to developing highly trained reflexologists
since 1976
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Membership Renewal Form 2009

* Credit Card Payment Only

Membership Fees (annual)

  • RCRT members $100 plus tax


  • Regular members $120 plus tax


  • RCRT membership $25 plus tax (covers three years)
Note: Any regular member wishing to join the RCRT programme
Note: should contact RAC Head Office

    Section 1 - Mailing Address
    Application Type* Renewal
    Member Type* Certified
    Associate
    Student
    Member No
    Certificate No
    Preferred Language* English French
    Other
    First Name*
    Last Name*
    Address*
    City*
    Province
    Country*
    Postal Code*
    Business Name
    Home Phone*
    Work Phone
    Cell Phone
    Work Fax
    Email
    Website
     
    Section 2 - Referral List Information
    Note: The following information is that which you want the public to have. The ability to be registered is only offered to RAC certified reflexologists in good standing.

    I confirm that I am RAC certified and I wish to have my name given out as a referral:

    Please complete all fields in this section:
    Allow Referrals* I Agree I Disagree
    Nearest Intersection
    Referral City
    Referral Province
    Referral Fields Work Phone
    Home Phone
    Cell Phone
    House Calls Yes No
     
    Section 3 - Demographic Information
    Note: The following information will only be used by the office for gathering data for medical/dental and other group insurance discount programs.
    Age Group 18-25 26-30 31-44
    45-54 55-64 65+
    Gender Female Male
    Marital Status Single Married
    Children Under 25
    Formal Education High School
    Some Post Secondary
    College Diploma
    University Degree
    Post Graduate
    Practice Frequency < 20hrs 21-30hrs
    30hrs+ per week
    Treatment Charge < $30 $30-$50
    $51+ per visit
    Practice Location
    Other Modalities
    Which products/services do you wish you could purchase at a group discount?
    Group Discounts
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    Section 4 - Comments & Suggestions
    Comments
    Wrap
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    Section 5 - Payment Details
    (Payable in Canadian funds only please.)
    Payment Method* Visa Master Card
    Amount*
    Name On Card*
    Card Number*
    Expiry Date*
     
    Section 6 - Contact Information Release
    I understand that the personal information I have given on this form is for the sole purpose of maintaining and enhancing my membership of the Reflexology Association of Canada and its Chapters and for use in the referral directory and that it may not be shared with any third party or used for any other purpose without my express permission in writing.

    I agree to pay a late penalty fee of $50 + tax if I do not renew within two months of my renewal due date.

    I also agree that if I do not renew my membership within 6 months after my membership expiration date, my membership will lapse and a rejoining fee of $75 + tax will be payable in addition to the membership fees.
    Acceptance I Agree I Disagree

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