IPODE - Registration

YOU ARE REGISTERING FOR:
Interprofessional Psychosocial Oncology: Introduction to Theory and PracticePlease select an item.

First Name A value is required. Last Name A value is required.

Discipline: If other:

What is your primary area of practice?

What is your highest level of education?

Do you practice in: ?

Are you a CAPO Member?

How did you hear about the course?

Are you being funded by an institute?

Are you a registered nurse?

E-Mail Address A value is required. Telephone A value is required.

MAILING ADDRESS:

Address A value is required

Address
City A value is required. Province Please select an item.
Postal Code A value is required.

CIVIC ADDRESS
If different from mailing address, please enter full street address (No PO Boxes).
This address will be used if we need to courier course materials.

Address
Address
City Province
Postal Code

PLEASE NOTE: As well as the independant study of course materials, students
will meet in a real-time, online seminar for 60 minutes each week. To help us
create the seminar groups, please indicate your availability:

**Group times may change. More options may be available at a later date.

ENGLISH TIME SLOTS:

First Choice Please select an item.

FRENCH TIME SLOTS:

Please select your choice for the French seminar:

Any additional comments or questions?



	Registration Technical Requirements Registration Fee Please ensure your computer and internet service both meet the technical requirements for course delivery		YOU ARE REGISTERING FOR: Interprofessional Psychosocial Oncology: Introduction to Theory and PracticePlease select an item. First Name A value is required. Last Name A value is required. Discipline: If other: What is your primary area of practice? What is your highest level of education? Do you practice in: ? Are you a CAPO Member? How did you hear about the course? Are you being funded by an institute? Are you a registered nurse? E-Mail Address A value is required. Telephone A value is required. MAILING ADDRESS: Address A value is required Address City A value is required. Province Please select an item. Postal Code A value is required. CIVIC ADDRESS If different from mailing address, please enter full street address (No PO Boxes). This address will be used if we need to courier course materials. Address Address City Province Postal Code PLEASE NOTE: As well as the independant study of course materials, students will meet in a real-time, online seminar for 60 minutes each week. To help us create the seminar groups, please indicate your availability: **Group times may change. More options may be available at a later date. ENGLISH TIME SLOTS: First Choice Please select an item. FRENCH TIME SLOTS: Please select your choice for the French seminar: Any additional comments or questions?