In accordance with NAPEG’s Privacy Policy, developed in response to the federal government’s Personal
Information Protection and Electronic Documents Act (PIPEDA) Bill C-6, the following is an
authorization concerning the release of personal information to designated third parties.
Consent Form
Please complete this form and return to NAPEG as soon as possible.
I understand that NAPEG retains certain personal information about me in its files. This information includes,
but is not limited to: my name; date of birth; home address; home email address; home phone number;
academic records; records of fee payments; and results of exams or tests that I have taken in order to qualify for
registration with the Association. I understand that I have the right to request at any time, in writing:
i. Access to the information NAPEG retains in its files, to verify that the information is correct and
up-to-date; and
ii. Removal of personal information held in NAPEG’s file on me, excluding information required
under The Engineering and Geoscience Professions Act. I understand that requesting the
destruction of such information may interfere with the processing of my annual renewal of
registration, if NAPEG is no longer able to contact me using the information retained.
NAPEG may disclose at any time, the name, title, business address, and business telephone number of a
member/licensee, as allowed under Bill C-6 (PIPEDA).
NAPEG will not disclose any personal information, such as home address, home phone number, or home e-mail
address, to any third party without written authorization from the member/licensee except where exempted by
law, or in accordance with NAPEG’s privacy policy. It is NAPEG’s policy, as a signatory to an agreement with
other constituent associations, to share information relating to discipline and enforcement matters.
Canadian Council of Professional Engineers (www.engineerscanada.ca) sponsors a range of products and
services that provide value-added benefits to all NAPEG registrants and their families. In so doing, NAPEG
provides your address to the suppliers of these products and services so that they can provide you with up-to-
date information on these services and products. Initial one selection only.
_____ Please include my home address on NAPEG mailing lists.
_____ Please include my business address on NAPEG mailing lists.
_____ Please do not include my name on NAPEG mailing lists to providers of such benefits.
Member/Licensee Number
Full Name
Print First Name; then Surname
Address
Signature and Date
Return completed form to NAPEG by fax: (867) 873-4058; email: bheppelle@napeg.nt.ca; or mail:
201, 4817 – 49th Street, Yellowknife, NT X1A 3S7
NAPEG
July 2009