Learning Institute Registration: After MAID: Walking Beside Families and Palliative Teams

Register for “After MAID: Walking Beside Families and Palliative Teams” taking place Wednesday, September 23, from 12:00pm – 3:30pm (Eastern) using the form below.

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INTERNAL - REGISTRATION STATUS (Does not account for Payment Status). To be filled out for all registrations.

REGISTRATION COMPLETE

REGISTRATION CANCELLED

REGISTRATION NEEDS CLARIFICATION

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INTERNAL - PAYMENT STATUS. To be filled out for all registrations.

PAID

AMOUNT OUTSTANDING

FREE

REFUNDED (For cancellation)

REFUNDED (For reasons other than cancellation)

TRANSFERRED TO ANOTHER REG (Not Charged Swap Fee)

TRANSFERRED TO ANOTHER REG (Charged Swap Fee)

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INTERNAL - REFUND STATUS. To be filled out ONLY if any type of refund is issued

NO PAYMENT WAS RECEIVED

FULL REFUND

PARTIAL REFUND

NO REFUND

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INTERNAL - REASON FOR REFUND.

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INTERNAL - Registration Amount. Amount paid for registration fee (Less refunded amount)

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INTERNAL - PROMO CODE USED.

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INTERNAL - AMOUNT REFUNDED. Total amount refunded.

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INTERNAL - Payment Confirmation Number / Cheque Number

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INTERNAL - Registration Amount

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Registration Information

Registration Types

Type	Rate
General Registration Eligible for member discount	$145.00 $95.00 with member discount
Student Registration Discount not applicable	$95.00

Member Discount

Members of Provincial Palliative Care Associations, CHPCA Associates, and CHPCA Affiliates are eligible to receive a $50 discount on General Registration only.

To apply the discount, please select General Registration, and then enter your Membership Validation Number in the "Promo Code OR Membership Validation Number" field in the payment section of this form.

The member discount cannot be applied to Student Registration.

If you do not have a validation number, please contact [email protected].

Multi-Session Bundles

Planning to attend multiple Learning Institute sessions? Multi-session bundles are available for individuals and organizations.

10-session bundle: $1,290 total
$129 per session
15-session bundle: $1,695 total
$113 per session
20-session bundle: $1,940 total
$97 per session

Sessions may be used by a single registrant attending multiple sessions or shared across an organization.

Organizations and individuals may purchase multiple bundles.

To purchase a multi-session bundle, please visit the bundle registration page.

For any questions about purchasing bundles, please contact [email protected].

Membership

To become a member, please contact your provincial palliative care association directly.

Please Select Registration Type(Required)

General Registration

Student Registration

To obtain the student discount please email your proof of student status to: [email protected]

To qualify for the student registration category, you must provide one of the following:

• A copy of your valid student ID showing the current date
• A copy of your current class registration
• A copy of your class schedule
• A copy of your tuition or school bill
• A letter from your institution or a current professor confirming your student status

Have you emailed your proof of student status?(Required)

Yes

Total

Attendee Information

Name:(Required)

First Last

Organization:(Required)

Job Title:(Required)

Email:(Required)

Enter Email Confirm Email

Address:(Required)

Street Address Address Line 2 City Province / State / Region Postal / Zip Code Country

Phone (preferably where you can be reached during the Learning Institute in case of emergency):(Required)

Extension:

Profession:(Required)

Please specify profession:(Required)

How did you hear about the Learning Institute?(Required)

Other: Please specify(Required)

Have you attended a CHPCA Learning Institute before?(Required)

Yes

Choose the type(s) of CHPCA Learning Institute(s) you have attended in the past(Required)

In-person conference

Virtual conference

Important Information

Accreditation
As this is the first year offering the Learning Institute in this format, sessions are not accredited. We are actively exploring accreditation for future offerings. In the meantime, participants who attend will receive a certificate of participation.

A list of Learning Institute participants will be provided to our partners, including Learning Institute sponsors. If you do not consent to receive these communications, please click on the opt-out button below.

I would like to opt out of receiving communications from partners.

Would you like to opt out of receiving future communications from the CHPCA?

This excludes communications related to the CHPCA Learning Institute. You will continue to receive important updates and information related to this event, regardless of your selection.

I would like to opt out of future communications from the CHPCA (e.g., newsletters, event invitations, updates).

Payment

Promo Code OR Membership Validation Number:

Grand Total:

Pay Online with a Credit Card

Payments are processed through PayPal. You do not need a PayPal account to complete your payment.

To pay by credit card:
• Click the blue PayPal button below
• Either log into your PayPal account or scroll down and select "Pay with a credit or Visa Debit card"

You will be directed to a secure page where you can enter your card details and complete your registration.

Your proof of student status must be submitted before completing your registration. Please email it to [email protected] before proceeding.