REGISTRATION FORM

ONLINE CONTINUING EDUCATION COURSE - HIA STEP BY STEP

OFFERED BY THE NATIONAL COLLABORATING CENTRE FOR HEALTHY PUBLIC POLICY (NCCHPP)

FROM JANUARY 23 TO FEBRUARY 24, 2017

Please note: you will be immediately redirected to the payment form after having completed this registration form.
Please have your credit card information (Visa or MasterCard) ready.

Minimum registration: 10; Maximum: 25.

Deadline for registration: Monday January 9, 2017 at 5 p.m. (Eastern Time)

PARTICIPANT INFORMATION
Firstname: Lastname:
Occupation*:
Field of expertise*:
Organisation*:
Please indicate the type of organisation in which you work*: Other, please specify:
Phone*: Extension:
Email: Email confirmation:
Address: City:
Postal code: Province: Country*:

Fields marked with an asterisk () are compulsory.*

#GST-HST 144876034

#QST 1022282286

I have read and accept the registration policy and wish to register for the Online Continuing Education Course - HIA Step by Step


PAYMENT
There is a $300 registration fee which is payable by credit card (Visa or MasterCard) via the secure online payment service CT Payment.
Click here to calculate the total amount, including the applicable taxes