Epilepsy Care Essentials:
Epilepsy Education Evening Registration (GTA)

Join us on February 5, 2025 from 6:00 - 8:00 PM, for a must-attend event designed for epileptologists and neurologists. This free event will be held at Byblos Uptown. 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 an exciting presentation on Autoimmune Epilepsy, followed by patient case discussions to support with your learning!

Acceptance of registration will be confirmed via email.

Question Title

1. Name (Required.)

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

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3. Phone (optional)

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4. Primary Clinical Role (Required.)

Community Neurologist

Epilepsy Specialist

Paediatric Neurologist

Adult Neurologist

Epileptologist

Other (please specify)

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

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6. Primary Clinic/Hospital Information (Required.)

Name

City

Postal Code

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

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8. Do you have any allergies or dietary restrictions? (Required.)

Yes (please specify)

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

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10. Thank you for completing the registration form. Please read the disclaimer below. We will do our best to accommodate your needs (Required.)

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: Epilepsy Education Evening Registration (GTA)

Question Title

* 1. Name (Required.)

Question Title

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

Question Title

* 3. Phone (optional)

Question Title

* 4. Primary Clinical Role (Required.)

Question Title

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

Question Title

* 6. Primary Clinic/Hospital Information (Required.)

Question Title

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

Question Title

* 8. Do you have any allergies or dietary restrictions? (Required.)

Question Title

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

Question Title

* 10. Thank you for completing the registration form. Please read the disclaimer below. We will do our best to accommodate your needs (Required.)

Epilepsy Care Essentials:
Epilepsy Education Evening Registration (GTA)

1. Name (Required.)

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

3. Phone (optional)

4. Primary Clinical Role (Required.)

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

6. Primary Clinic/Hospital Information (Required.)

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

8. Do you have any allergies or dietary restrictions? (Required.)

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

10. Thank you for completing the registration form. Please read the disclaimer below. We will do our best to accommodate your needs (Required.)