Request for Registry Termination

Registrants who choose to terminate certification with the College must complete the Request for Registry Termination.

Failure to do so will result in the Registrant being listed as ‘Suspended’ on the public registry for up to 12 months.

Please complete the application below for Registry termination.

Request for Registry Termination Form

This form must be completed and the administration fee paid through PayPal to complete termination of your College registration with removal of your name and contact information from the Public Registry. Failure to do so will result in your registry being listed as ‘Suspended’. Please note that a Suspended Registrant will be public from 3-12 months, depending on current College Policy.
Date

Date Format: MM slash DD slash YYYY
Name

First

Last
Credential(s) and Registration #:
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Email
Please indicate the reason for cancelling your certificate of registration :
- Leaving the country
- Changing profession Leaving the VR or VE Field
- Returning to School – different Profession
- Retiring – no longer practicing
- Other – please explain below
Please provide 'Other' reason request for registered termination:
Administrative Fee for registry removal*

Price: $ 25.00 CAD

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