Note: Please provide us your legal name and title which you would like to appear on your CBAM certificate(s).Name* First Middle Last Email* Please type here your exact name with the title combination you wish to appear on your certificate(s). (The capitalization of the titles before and after your name will be manually corrected and then added to your records.)*Examples of combinations: Dr. John Smith Dr. John Smith MD John Smith MD John Michael Smith MD John Smith NP John Smith RN John Smith RPNPlease upload a document(s) that supports your title or designation:* Drop files here or Select files Max. file size: 256 MB. * By submitting this form, I certify all the provided information is true and correct and Canadian Board of Aesthetic Medicine is released from any liability if the above information is not correct.