<p> MEDICAL DEVICE REPROCESSING ASSOCIATION OF NOVA SCOTIA (MDRANS)</p><p>MEMBERSHIP APPLICATION $40.00 Membership fees are payable in full for 2 years Due: November 1, 2016.-expires October 31, 2018 Name: (Last)______(First)______</p><p>Current MDRANS member: Yes ( ) Please provide membership number______No ( ) Last year of membership______</p><p>Home Address Street City/Province Postal Code Home Phone</p><p>Hospital/Employer Name______Street City/Province Postal Code Work Phone</p><p>Email Address</p><p>Present Position Technician Education Clinical Resource Management Other</p><p>MDRT Certification: Yes ( ) Through Whom: ______No ( ) Currently Enrolled in an educational program: Yes ( ) No ( ) If yes, please explain ______Status Full-Time Part-Time Casual Retired Other</p><p>Highest Academic Achievement: ______</p><p>Signature: ______Date: ______</p><p>Mail Membership Application and cheque to: Barbara Young Dartmouth General Hospital Sterile Processing Dept. 325 Pleasant Street, Suite 1706 Dartmouth Nova Scotia B2Y 4G8</p>