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Membership Application Form

We’re glad you’ve chosen to join a national community of professionals dedicated to MAiD practice in Canada.

Please complete the application below. Your application will be reviewed to confirm eligibility, and you will be notified by email once a decision has been made.

Payment will be processed only upon approval of your application.

Account Information

Please create a username and password. Your password must be at least 8 characters long and contain upper and lowercase letters, a number, and a special character.

Username(Required)

Password(Required)

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Name(Required)

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Email(Required)

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Professional Information and Verification

Please complete the following fields for your membership record. For renewals, please ensure your information is correct and up to date.

Street Address(Required)

City(Required)

Province(Required)

Country(Required)

Postal Code(Required)

Phone Number(Required)

Scope of MAiD practice(Required)

Please note: Provider refers to clinicians who have already independently administered or prescribed MAiD. Assessor refers to those who have independently conducted eligibility assessments but have not administered or prescribed MAiD. Care Coordinator refers to those health professionals who help administer and coordinate organized MAID programs in an institutional or local setting. If Other, please describe in the field below.

Specific involvement in MAiD (if not included above)

Medical background(Required)

Medical specialty (if applicable)

Licensing body (Required for verification purposes)

License number (Required for verification purposes)

Personal Attestation

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.

Administered MAiD Attestation(Required)

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

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.

Assessed for MAiD Attestation(Required)

I attest that in the past 12 months, I have assessed medical assistance in dying.

Yes

Membership reference

To ensure a safe and respectful community, CAMAP requires that applicants provide a reference who can attest to their current or future involvement in MAiD-related activities. This includes, but is not limited to, a current or former member of CAMAP, an administrator or manager within the MAiD community, or a MAiD or medical program director/health authority administrator who grants MAiD-related privileges. Please enter your reference's name and email address here; they will receive an automated email requesting verification of your role in MAiD

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

Reference Name(Required)

Reference Email(Required)

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View the Membership agreement

Membership Application Form

Account Information

Professional Information and Verification

Personal Attestation

Membership reference

Organization Information

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