Please fill out the form and then fax to Professional Development at (780) 426-1877.

Member No.:
Name:

Practicing and non-practicing Professional Members, Licensees and Registered Professional Technologists must annually report the following information. (Students, Examination Candidates, MIT's and Life Members are exempt from this requirement.)

• Practicing: Members registered for one year or more must confirm or change their previous years' answers to items 1, 2 and 3 and answer item 4 by indicating the number of PDHs they wish to claim in each category for the most recent 12 month period.
• Non-Practicing: Members who wish to retain a non-practicing status or who wish to change their status to non-practicing need answer item 1 only.
• New Members: Members recently having received their professional designation, must answer items 1, 2 and 3 only.
• Reinstating Members: Members recently reinstated should follow the instructions on their reinstatement letter.

1. Practicing Status: Confirm your status or request a change by checking one of the boxes. If non-practicing you need only to sign and date the bottom. Practicing Non-Practicing

2. Industries of Practice Confirm codes At member suggestion, some changes have been made. Cross out existing codes that are to be deleted. Add new codes in the boxes provided. There can be only three active codes.

If choosing 056, please specify

3. Areas of Specialization Confirm codes. At member suggestion, some changes have been made. Cross out existing codes that are to be deleted. Add new codes in the boxes provided. There can only be three active codes.

If choosing 999, please specify

4. Professional Development Hours: A minimum of 240 hours over three years must be claimed with activities claimed in at least three of the six categories. Please do not send supporting documentation. Category definitions are outlined in the CPD Guideline.