1.

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* 1. Date:

Date / Time

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* 2. First Name

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* 3. Middle Initial (or N/A)

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* 4. Last Name

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* 5. Preferred Email Address (all correspondence will go to this email)

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* 6. Alternate email (in case your preferred email changes)

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* 7. Preferred Phone Number

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* 8. Alternate Phone Number

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* 9. Have you been enrolled in the CPD program before; or have a University of Calgary user account?

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* 10. Place of Employment

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* 11. Do you work in an urban or rural setting? (select both if it applies)

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* 12. City/Town

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* 14. Do you currently provide clinical services to children or youth with addiction or mental health issues?

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* 15. Your Professional Education (Registered professions / Master's Degree preferred). If you are in Education, please see the MORE program at www.hmhc.ca/more.html 

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* 16. When the courses are closed at the end of the month, would you like to be automatically enrolled in the archived version of the course?

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* 17. If the course is full when we receive your registration, would you be willing to instead take a shorter (no discussion board) archived version of the same course, for partial credit?

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* 18. How Did You Hear About Us?

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* 19. Please enter any comments here.

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* 20. Please select which course you would like to enroll in:

Please click DONE to send your choices to us!
The system doesn't send a confirmation message but, unless you receive an error notification, we will have received your request.
If this is a new account, please note it may take a few days to receive your login instructions and password. Thanks in advance for your patience and we hope you enjoy your course selections! 
~ The CPD Team ~

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