Membership Committee Portal

ID#: 30970 -- Kaitlin De Brabandere - Student

STUDENT Member Application Form

Kaitlin De Brabandere - Student

1. PERSONAL INFORMATION:
Prefix:
First Name: Kaitlin
Middle Name:
Last Name: De Brabandere

2. OSTEOPATHIC EDUCATIONAL BACKGROUND
Canadian Academy of Osteopathy (CAO)
66 Ottawa Street
Hamilton, Ontario L8H 3Z1
Canada

3. WHAT WAS YOUR LANGUAGE OF OSTEOPATHIC INSTRUCTION: English

OTHER MEMBERSHIPS

Other Body - Current: No
Other Body - Previous: No

REGULATORY BODIES

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

DECLARATIONS

Yes: Provide the OAO within 30 days with details of any current change, proceedings or finding of guilt for a criminal offence in any jurisdiction and a current charge, proceeding or finding of negligence, professional misconduct, incompetency or incapacity in any jurisdiction, arising from osteopathic practice or any other health profession.

Yes: Advise the OAO within 30 days of any changes in personal information, work details or liability insurance Coverage

Yes: I hereby certify that the statements made in this application, including any attachments are true and correct to the best of my knowledge and belief. I understand that even one false or misleading statement may disqualify me from membership or may cause for revocation of membership that has been granted to me. I authorize the OAO to make inquiries to verify the information provided.

FEES PAID

Fees: $0.00

Fees PAID: No

ID#: 30934 -- Alicia Grant - Student

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STUDENT Member Application Form

Alicia Grant - Student

1. PERSONAL INFORMATION:
Prefix: Ms
First Name: Alicia
Middle Name: Marjorie
Last Name: Grant

2. OSTEOPATHIC EDUCATIONAL BACKGROUND
Swiss International College of Osteopathy (SICO) (Switzerland)
Zinnenstrasse 7
Weggis 6353
Switzerland

3. WHAT WAS YOUR LANGUAGE OF OSTEOPATHIC INSTRUCTION: English

OTHER MEMBERSHIPS

Other Body - Current: No
Other Body - Previous: No

REGULATORY BODIES

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

DECLARATIONS

Yes: Advise the OAO within 30 days of any changes in personal information, work details or liability insurance Coverage

FEES PAID

Fees: $0.00

Fees PAID: No

ID#: 30938 -- Jeremy Hudson - Student

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STUDENT Member Application Form

Jeremy Hudson - Student

1. PERSONAL INFORMATION:
Prefix: Mr
First Name: Jeremy
Middle Name:
Last Name: Hudson

2. OSTEOPATHIC EDUCATIONAL BACKGROUND
Canadian College of Osteopathy (CCO)
102-150 Bridgeland Ave.
North York, Ontario M6A 1Z5
Canada

3. WHAT WAS YOUR LANGUAGE OF OSTEOPATHIC INSTRUCTION: English

OTHER MEMBERSHIPS

Other Body - Current: No
Other Body - Previous: No

REGULATORY BODIES

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

DECLARATIONS

Yes: Advise the OAO within 30 days of any changes in personal information, work details or liability insurance Coverage

FEES PAID

Fees: $0.00

Fees PAID: No

ID#: 30974 -- Matteo Iannace - Student

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STUDENT Member Application Form

Matteo Iannace - Student

1. PERSONAL INFORMATION:
Prefix: Mr
First Name: Matteo
Middle Name: f
Last Name: Iannace

2. OSTEOPATHIC EDUCATIONAL BACKGROUND
Canadian College of Osteopathy (CCO)
150 Bridgeland Ave
Toronto, Ontario M6A 1Z5
Canada

3. WHAT WAS YOUR LANGUAGE OF OSTEOPATHIC INSTRUCTION: English

OTHER MEMBERSHIPS

Other Body - Current: Yes
Other Body - Previous: Yes

REGULATORY BODIES

Body Name: College of Kinesiologists of Ontario
Registration Date: 10/10/2017
Registry Name: Matteo Iannace
Prov/Ctry: ON, Canada
Reg#: 14931
URL:

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

DECLARATIONS

Yes: Advise the OAO within 30 days of any changes in personal information, work details or liability insurance Coverage

FEES PAID

Fees: $0.00

Fees PAID: No

ID#: 30950 -- Robert Lee - Student

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STUDENT Member Application Form

Robert Lee - Student

1. PERSONAL INFORMATION:
Prefix: Mr
First Name: Robert
Middle Name:
Last Name: Lee

2. OSTEOPATHIC EDUCATIONAL BACKGROUND
Canadian College of Osteopathy (CCO)
151 Bridgeland Avenue
North York, Ontario M6A 1Z5
Canada

3. WHAT WAS YOUR LANGUAGE OF OSTEOPATHIC INSTRUCTION: English

OTHER MEMBERSHIPS

Other Body - Current: Yes
Other Body - Previous: No

REGULATORY BODIES

Body Name: College of Massage Therapists of Ontario
Registration Date: 10/01/2007
Registry Name: Robert Lee
Prov/Ctry: ON, Canada
Reg#: M666
URL:

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

DECLARATIONS

Yes: Advise the OAO within 30 days of any changes in personal information, work details or liability insurance Coverage

FEES PAID

Fees: $0.00

Fees PAID: No

ID#: 30618 -- Tina Szeto - Student

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STUDENT Member Application Form

Tina Szeto - Student

1. PERSONAL INFORMATION:
Prefix: Ms
First Name: Tina
Middle Name: Tin-Yuk
Last Name: Szeto

2. OSTEOPATHIC EDUCATIONAL BACKGROUND
Canadian College of Osteopathy (CCO)
150 Bridgeland Ave
Unit 102
Toronto, Ontario M6A 1Z5
Canada

3. WHAT WAS YOUR LANGUAGE OF OSTEOPATHIC INSTRUCTION: English

OTHER MEMBERSHIPS

Other Body - Current: Yes
Other Body - Previous: No

REGULATORY BODIES

Body Name: College of Kinesiologists of Ontario
Registration Date: 05/05/2017
Registry Name: Tina Tin-Yuk Szeto
Prov/Ctry: ON, Canada
Reg#: 14038
URL:

Body Name: Canadian Athletic Therapists Association
Registration Date: 06/14/2004
Registry Name: Tina T Szeto
Prov/Ctry: ON, Canada
Reg#: 2-2930
URL:

DECLARATIONS

Yes: Advise the OAO within 30 days of any changes in personal information, work details or liability insurance Coverage

FEES PAID

Fees: $0.00

Fees PAID: No

ID#: 30029 -- Suzanne Wolff - Student

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STUDENT Member Application Form

Suzanne Wolff - Student

1. PERSONAL INFORMATION:
Prefix: Mrs
First Name: Suzanne
Middle Name: Julian
Last Name: Wolff

2. OSTEOPATHIC EDUCATIONAL BACKGROUND
Canadian College of Osteopathy (CCO)

3. WHAT WAS YOUR LANGUAGE OF OSTEOPATHIC INSTRUCTION: English

OTHER MEMBERSHIPS

Other Body - Current:
Other Body - Previous:

REGULATORY BODIES

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

Body Name:
Registration Date:
Registry Name:
Prov/Ctry: ,
Reg#:
URL:

DECLARATIONS

: Provide the OAO within 30 days with details of any current change, proceedings or finding of guilt for a criminal offence in any jurisdiction and a current charge, proceeding or finding of negligence, professional misconduct, incompetency or incapacity in any jurisdiction, arising from osteopathic practice or any other health profession.

: Advise the OAO within 30 days of any changes in personal information, work details or liability insurance Coverage

: I hereby certify that the statements made in this application, including any attachments are true and correct to the best of my knowledge and belief. I understand that even one false or misleading statement may disqualify me from membership or may cause for revocation of membership that has been granted to me. I authorize the OAO to make inquiries to verify the information provided.

FEES PAID

Fees: $0.00

Fees PAID: No