| Membership
Application Form |
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(Please print this application out and complete. Printer friendly version)
Business Information:
Name:________________________________________________________________________
Business Name: ________________________________________________________________
Business Address:_______________________________________________________________
City:______________________________Province:___________ Postal Code
______________
Business Phone: (____)________________________ Fax:
(____)_________________________
Email:________________________________Web Address:_____________________________
Electrolysis Training Information:
Name of Training
School:_________________________________________________________
Address: ______________________________________________Province:________________
Postal Code:_____________Phone:
(____)____________Email:__________________________
Date of Graduation:________________________Hours of Training:
______________________
Other Continuing Education and Certification:
(Enter date you passed these exams and forward a photocopy of
certificate with application)
I certify that I am using 3rd Party verification of sterilization and I apply for membership:
| _________________________________________________ | _______________________ |
| Signature of applicant | Date |
Sponsoring COPE Member's Name:______________________________Cope #_________
(List, above, the COPE National Member (if any) that was instrumental in your request to join COPE National).
Mailing Your Application For Membership
Mail application, check and copies of diplomašs and certifications to:
Melissa Newton
COPE Membership Chairman
29530 Sun Valley Cres.
Abbotsford, B.C. V4X 1J2
Phone: 1-504-857-4911 or Email: mknewton@dowco.com
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