GOClic Website

Membership

For health care professionals specializing in gynecologic cancer prevention and care Sign up now

Join GOC

Please take a moment and fill out this form below...  What you will need to fill out the on-line application:
  • your education/training details plus names and emails of active GOC members who have made and seconded your nomination
  • your curriculum vitae
  • your credit card. You will also have the option of submitting your application and paying later via cheque.
All fields marked with an *asterisk* need to be completed in order to submit the application.
Section A

Membership Category

Member Category 2 - Other than physician

You are a nurse, allied health professional or scientist who commit a substantial portion of their professional time to the advancement of gynecologic oncology but would not be eligible to be a Category 1 Member of the Corporation.

Account Details

Section B

Nomination / Recommendation for Membership

GOC membership requires nomination and seconding by two active members. For Associate Resident membership, the nominating member is an active GOC member and the seconding member is either your Department Chair or your Postgraduate Program Director.

Nominating Member

Full Name (Ref 1)

Email Address

Seconding Member

Full Name (Ref 2)

Email Address

*Note: the nominating and seconding members will automatically receive an email asking them to confirm their support of your application.

Section C

Your Personal Information and Coordinates

Department

Organization

Street Address - Line 1

Street Address - Line 2

City

Province

Postal Code

Country

Salutation

First Name (required)

Last Name

Birthdate

Preferred Email Address

Alternate Email Address

e.g. (123) 456-7891

Mobile Phone Number

e.g. (123) 456-7891

Full Name (Ref 1)

Email Address

Full Name (Ref 2)

Email Address

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Correspondence

Title / Position

Centre / Institution

Department

division for department

Division

division for department

Street Address

City

Country

Province / State

Postal / Zip Code

Office Phone

Ext

e.g. (123) 456-7891

Fax Number

e.g. (123) 456-7891

Correspondence

Street Address

City

Country

Province / State

Postal / Zip Code

Home Phone Number

Please check all that apply

Professional Abbreviation

Please check all that apply

Other: Please Specify

Please check all that apply

Certifications

Please check all that apply

Certifications : If other, Please Specify

committee group

Committee group

committee group

MD obtained in

Residency in

Month/Year

Started in

Month/Year

and completed / to be completed in

At University

Fellowship training in

Started fellowship in

and completed / to be completed in

At University

Other Training

Other training started in

and completed / to be completed in

At University

PhD in

obtained in / expected to be completed in

Post-doctoral fellowship in

obtained in / expected to be completed in

Degree obtained in

At University

RN obtained in

At University

RN(EC) obtained in

At University

My Professional Practice

Type of Clinical Practice

University Appointment

Please Specify

% of Professional time spent in Gynecologic Oncology

Clinical %

Teaching %

Research %

Admin %

Expertise or Special Interest(s) (check all that apply)

Please specify

Area(s) of Expertise/Interest: (check all that apply)

Please Specify

Biography

Shows some information first-thing to users who visit your profile

Notes

Shows some information first-thing to users who visit your profile

User Profile Upload

Emergency Contact

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone Number

Work Coordinates

Correspondence

Title / Position

Centre / Institution

Department

division for department

Division

division for department

Street Address

City

Country

Province / State

Postal / Zip Code

Office Phone

Ext

e.g. (123) 456-7891

Fax Number

e.g. (123) 456-7891

Home Coordinates

Correspondence

Street Address

City

Country

Province / State

Postal / Zip Code

Home Phone Number
Section D

Your Professional Training, Practice and Interests

Please check all that apply

Please check all that apply

Professional Abbreviation

Please check all that apply

Other: Please Specify

Please check all that apply

Certifications

Please check all that apply

Certifications : If other, Please Specify

For MDs

MD obtained in

Residency in

Month/Year

Started in

Month/Year

and completed / to be completed in

At University

Fellowship training in

Started fellowship in

and completed / to be completed in

At University

Other Training

Other training started in

and completed / to be completed in

At University

For PHDs

PhD in

obtained in / expected to be completed in

Post-doctoral fellowship in

obtained in / expected to be completed in

For Nurses

Degree obtained in

At University

RN obtained in

At University

RN(EC) obtained in

At University

My Professional Practice

Type of Clinical Practice

University Appointment

Please Specify

% of Professional time spent in Gynecologic Oncology

Clinical %

Teaching %

Research %

Admin %

Expertise or Special Interest(s) (check all that apply)

Please specify

Area(s) of Expertise/Interest: (check all that apply)

Please Specify
Section E

Newsletter Sign-Up

Section F

Acknowledgement & Consent

Section G

Provisional Membership and Initial Dues Payment

Acceptance of your application by the Membership Committee will provide you with Provisional Membership until it is presented to and approved by the Board of Directors. The membership year begins on January 1st and ends December 31st.

You are required to make a dues payment with your application. This first payment is pro-rated from the date of application until the end of the current year. Membership renewal notices will be sent out during the month of December every year.

If you apply for membership from: For Member Category 1, Member Category 2 (MDs) and Member International, the prorated dues amount is: For Member Category 2 (Others), Associate, the prorated dues amount is:
January to March $300.00 $100.00
April to June $225.00 $75.00
July to September $150.00 $50.00
October to December $75.00 $25.00
Category 1, Category 2 (MD), International Category 2, Associate
January to March
$300.00 $100.00
April to June
$225.00 $$75.00
July to September
$150.00 $50.00
October to December
$75.00 $25.00
Please Note that the CV is mandatory,
     and must be submitted upon the
          completion of this form.

Our Partners

The Society of Gynecologic Oncology of Canada welcomes and values industry partnerships.

GOC acknowledges the ongoing support of these dedicated partners for their commitment to gynecologic oncology in Canada. Thank you.

Become a Partner