C-26, r. 6 - Regulation respecting standards for the issue and holding of radiology permits

Schedule Disposition versions

2012-09-01

SCHEDULE 2

(s. 7)

REGISTRATION FOR THE EXAMINATION

I, the undersigned, ____________________________________________________________________

residing at __________________________________________________________________________

hereby declare that:

(1) I am entered on the roll of the Ordre professionnel des ___________________________________

(2) My consulting-room is located at ___________________________________________________

(3) I wish to register for the examination in radiology that will take place on ____________________

_____________________________________ _____________________________________

date member’s signature

O.C. 1210-87, Sch. 2.