Apply Online

To apply, please fill in the form below. Required fields are indicated by bold font. The information requested below is the same as that on the mail-in form, with the exception that this online form sends all information in electronic format.

Note: Please enter your business address rather than your personal one as it is displayed to the public on this website.

Membership Type

Select the type of membership. Please see Membership Information for an explanation of the types of membership.

Type of membership:	Junior Fellow Affiliate
	Status Change

Contact Information

First Name:

Last Name:

Institution:

Department:

Current Address:

City:

Province:

Other:

Postal Code:

Country:

Telephone:

Fax:

Email:

Second Email:

Website:

Sponsorship

Enter the name and address of your sponsor. The sponsor must be a current member of the Canadian College of Neuropsychopharmacology,
and must have Fellow or Affiliate status.

For Fellow applications, your sponsor MUST be a CCNP member for at least one year. Provisional junior members can sponsor another junior member application.

Sponsor Name:

Sponsor Address:

Professional Information

Designations (e.g. MD, PhD, FRCP):

Position:

Second Position:

Summary of research interests:

Select the documents to accompany your application.

Please that those applying for Junior Membership are not required to submit recent publications.

All documents must be in Word, WordPerfect, or PDF format.
The form may take a long time to process for large documents, please be patient.

The total size of the documents must not exceed 4 MB.

Curriculum Vitae:

Publication 1:

Publication 2:

Publication 3: