Renewal Attestation and Verification

Name(Required)

First Last

Email(Required)

Personal Attestation

MAiD Role(Required)

Please select your role, Assessor or Provider. If you are a Provider, it is assumed that you are also an Assessor.

As part of CAMAP’s commitment to maintaining a safe, trusted, and professional community, applicants for Provider membership are required to complete a personal attestation confirming their current and independent involvement in MAiD practice. This information supports our membership verification process and helps ensure appropriate access to role-specific resources and forums. This attestation is required annually to maintain Provider membership status.

I attest that in the past 12 months, I have administered medical assistance in dying.(Required)

Yes

As part of CAMAP’s commitment to maintaining a safe, trusted, and professional community, applicants for Assessor membership are required to complete a personal attestation confirming their current and independent involvement in MAiD practice. This information supports our membership verification process and helps ensure appropriate access to role-specific resources and forums. This attestation is required annually to maintain Assessor membership status.

I attest that in the past 12 months, I have assessed for medical assistance in dying.(Required)

Yes

Attestation reference

Please provide a reference who can confirm your current and independent involvement in MAiD practice.

Please do not enter your own email address. Doing so will delay approval of your renewal request.

Reference Name(Required)

Reference Email(Required)

Enter Email Confirm Email

Personal Attestation

Attestation reference

Organization Information

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