Full Name

RCIC Number

Company/Organization Name

Business Address (Street/Suite)

City

Province

AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanOther

Postal Code

Phone Number (e.g., (XXX) XXX-XXXX)

Email Address

Website (Optional)

Professional Background

Years of Experience in Immigration Consulting

Specializations (type all applicable areas of immigration practice)

Languages Spoken

your referral

Declaration and Commitments

I am a Regulated Canadian Immigration Consultant (RCIC) in good standing with the College of Immigration and Citizenship Consultants (CICC).

I uphold the highest standards of integrity, professionalism, and ethical conduct. I have no criminal convictions and am not subject to any current professional investigations.

I pledge to support PICAC’s mission and values, adhere to its bylaws, and act transparently and ethically in all professional matters.

I hereby apply for membership in PICAC and affirm that the information provided is accurate and true. I agree to uphold the association’s values of professionalism, transparency, and ethical practice.