EPM
Programs ⦒  EPM ⦒  Registration

Essential Pain Management (EPM)

Registration Form

Location
When
Full Name
Required: Full Name
Address Line 1
Address Line 2
City
Select Online or Cheque
Required: City
Postal Code
Enter Your Postal Code
Phone
Valid Phone Number (###) ### - ####
Email
Valid Email Address xx@yy.zz
Discipline
  
Select Your Discipline
Workplace: / Volunteer /  Organization
Work
Required: Workplace
Comments
Payment
Payment
  
Select Online or Cheque
Email Authorization

1. PPSMCP-SWO may email me information about research opportunities regarding our education programs:

Consent
  
Select Yes or No

2. PPSMCP-SWO may email me information about future PPSMC program education and events:

Consent
  
Select Yes or No

Thank you for updating this information. We take your privacy seriously and we commit and confirm that we will not share your details and information and would only make contact directly with you from this program related to the two requests above. We maintain our registration information for 10 years.

Verify 

Support

Palliative Care Education, Consultation & System Development