Epilepsy Care Essentials:
Case Conversations about Epilepsy Care and Management Registration

Join us on February 12, 2025 from 6:00 - 8:00 PM, for a must-attend event designed for neurologists, epileptologists, and other healthcare professionals. This free event will be held at the Ivey Spencer Leadership Centre in London, ON. Complimentary food and non-alcoholic drinks will be provided!

Be prepared to connect with like-minded professionals and expand your knowledge in epilepsy care and management through diverse patient case presentations followed by an interactive discussion.

Acceptance of registration will be confirmed via email.

Question Title

* 1. Name

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* 2. Email (Please ensure to review prior to clicking submit)

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* 3. Phone (optional)

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* 4. Primary Clinical Role

Community Neurologist

Paediatric Neurologist

Adult Neurologist

Epileptologist

Neurology Resident/Fellow

Registered Nurse

Nurse Practitioner

Other (please specify)

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* 5. If you are a Neurology Resident or Fellow, please indicate your Post-Grad Year (PGY) or Fellowship

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* 6. Do you have a specialty (i.e., mental health, genetics, neonatal, etc.)?

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* 7. Primary Clinic/Hospital Information

Name

City

Postal Code

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* 8. Primary Practice Setting (please select the option that best describes your practice setting)

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* 9. Do you have any allergies or dietary restrictions?

Yes (please specify)

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* 10. Do you have any accessibility requirements you would like us to be aware of to ensure the event is comfortable for you?

Question Title

* 11. Thank you for completing the registration form. Please read the disclaimer below. We will do our best to accommodate your needs for this event.

I understand that photos/videos will be taken during this event and will only be used for promotional purposes on the Project ECHO Epilepsy website and social media platforms. I will contact Shakeera Baker, Education Administrative Coordinator for any questions or concerns.

Epilepsy Care Essentials: Case Conversations about Epilepsy Care and Management Registration

Question Title

* 1. Name

Question Title

* 2. Email (Please ensure to review prior to clicking submit)

Question Title

* 3. Phone (optional)

Question Title

* 4. Primary Clinical Role

Question Title

* 5. If you are a Neurology Resident or Fellow, please indicate your Post-Grad Year (PGY) or Fellowship

Question Title

* 6. Do you have a specialty (i.e., mental health, genetics, neonatal, etc.)?

Question Title

* 7. Primary Clinic/Hospital Information

Question Title

* 8. Primary Practice Setting (please select the option that best describes your practice setting)

Question Title

* 9. Do you have any allergies or dietary restrictions?

Question Title

* 10. Do you have any accessibility requirements you would like us to be aware of to ensure the event is comfortable for you?

Question Title

* 11. Thank you for completing the registration form. Please read the disclaimer below. We will do our best to accommodate your needs for this event.

Epilepsy Care Essentials:
Case Conversations about Epilepsy Care and Management Registration