Request an education session
Education sessions are available for the following physician groups: *
CMPA Member
We require a CMPA member to sponsor requests for CMPA education sessions
CMPA Member Name: *
Your answer
E-mail: *
Your answer
Office telephone: *
Your answer
Cell or home telephone: *
Your answer
Logistics: Event coordinator or organizer
(if not the CMPA member)
Event coordinator or organizer name:
Your answer
Telephone:
Your answer
E-mail:
Your answer
Fax:
Your answer
Session details
Language of session: *
Will this session be videoconferenced? *
Location of education session:
Venue:
Your answer
Address:
Your answer
City: *
Your answer
Province: *
Number of participants? *
Intended for groups of 20 CMPA member attendees or more
Your answer
Preferred date and time
(Please include optional dates when possible)
Option 1:
Date: *
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/
YYYY
From: *
Time
:
To: *
Time
:
Option 2:
Date:
MM
/
DD
/
YYYY
From:
Time
:
To:
Time
:
Option 3:
Date:
MM
/
DD
/
YYYY
From:
Time
:
To:
Time
:
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