2017 Membership Registration

2017 CRTPA Membership Registration

If you are not currently a CRT / MT - complete the Guest Registration form:

* Indicates required field

I am currently employed as a Circuit Rider Trainer or as a Maintenance Trainer *

Yes No

If you answered yes to this question, please complete the remainder of the registration form.
If you answered NO - please complete the AGM registration form for guests.

Are you attending the Vancouver AGM August 22-24, 2017? *

Yes No

If you are attending, do you have any specific dietary needs? (ie. Vegetarian, allergies) If yes, please explain *

Personal Information

Name *

First

Last

Address *

City *

Prov/Territory *

Postal Code *

Phone / Cell Number *

Fax Number *

Email *

Preferred Communication *

Age Range *

Employer Information (CRTP SERVICE PROVIDER)

Contact Name *

Office Address *

City *

Province *

Postal Code *

Phone / Cell Number *

Experience

(If you do not have experience in a particular area, enter 0)

How many years have you been employed with the current CRTP Service Provider? *

How many years have you delivered training employed as a trainer in the Water Treatment and Distribution Systems? *

How many years have you delivered training employed ast a trainer in the Wastewater Collection and Treatment Systems *

How many years have you delivered training employed as a trainer in Building Systems and Maintenance? *

Education

Did you receive a high school diploma? *

Yes No

Did you receive a diploma or degree from a post-secondary institution (university or college)? *

Yes No

If you answered yes above, what was your major or course of study for the diploma or degree received? *

Trades, Certificates or Professional Designation

What trade certificates have you acquired in your work career? (plumber, electrician, carpenter etc.) If none, please just state "None" *

What skill or level expertise have you obtained provincially in the trade indicated above? (apprentice, journeyman or master) *

What level of provincial certification do you hold?

Specialized Skills

Computer Skills

What computer operating system are you familiar with and use daily? *

Windows OS Apple OS Other

(Describe other) *

Laboratory and Field Equipment

Are you interested in career advancement in your current field of work? Advancing to supervisor, management or independent service provider? *

Yes No

Do you see education as the key to advancement in your work career? *

Yes No

How would you choose to advance your education *

Return to school Distance learning Community college University

Professional designation received (NA if not applicable) *

Have you taken a "Train the Trainer" course? (Other than at the CRTPA AGM) *

Yes No

Name of the training *

How many operators are you currently training? *

How many communities do you visit to provide training as a CRT? *

Do you have any health concerns related with your work as a CRT? *

What suggestions would you offer to improve the CRTPA? *

Submit