Member Attestation Renewal Verification

Member Name

Name(Required)

First Last

Email(Required)

Are you a current or past CAMAP member?(Required)

Yes - Current

Yes – Past

No

Attestation - 12 months(Required)

To the best of your knowledge, has the member independently completed a MAiD assessment or provided MAiD within the past 12 months?

Yes

No

Unsure

If Yes:(Required)

MAiD assessment

MAiD provision

Both

Declaration(Required)

I confirm that the information provided is accurate to the best of my knowledge.

The Canadian leader for the community of professionals involved in medical assistance in dying (MAiD).

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