Management Consulting Diploma Application Form

Management Consulting Diploma Application Form Your first step towArds obtAining the cmc designAtion

first Name:

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Salutation:

Mr

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Ms

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Mrs

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Last Name: Dr

Gender:

Date of Birth: (dd/mm/yyyy)

Address:

City:

Province:

Home Telephone:

Cell:

Email:

Postal Code:

EDUCATIONAL REqUIREMENTS COMPLETED (attach transcripts and/or Certificates of Completion)

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Currently Employed as a Consultant: Course

Yes

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No

Course number

Essentials of Management Consulting

Institution

Completed (mm/yy)

Ethical Behaviour: Best Practices of Management Consultants Project Management Personal Skills Interpersonal Skills When do you anticipate you will have completed the experience requirements for the Certified Management Consultant (CMC) designation?

DIPLOMA fEES AND PAYMENT

$150 + GST/HST.

Diploma fee is $300 GST/HST# 102497997 RT

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Method:

Card Number:

Credit Card

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Price valid until August 31, 2017

Cheque (payable to CMC-Canada)

Amount: Expiry:

Print Name:

Application checklist:

5%

SK

10% $15.00

AB

MB ON NB

Signature:

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Personal information complete

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Transcript/ certificates of completion attached

Canadian Association of Management Consultants | Association canadienne des conseillers en management 701, 372 Bay St., Toronto ON M5H 2W9 Canada T: 416-860-1515 or 1-800-268-1148 | f: 416-860-1535 or 1-800-662-2972 [email protected] | cmc-canada.ca

GST/HST $7.50 PE 14% $21.00

BC

5%

$7.50

13% $19.50 13% $19.50 13% $19.50

Date Received

Date Approved Approved by

NS

15% $22.50

NT

5%

$7.50

5%

$7.50

NL YT

NU

13% $19.50 5%

OFFICE USE

$7.50