St. Michael's Hospital, Toronto, Ontario (April 14 to June 23, 2018)

Registration

* 1. FIRST NAME

* 2. LAST NAME

* 3. PREFERRED EMAIL (RECEIPT AND HANDOUT INFORMATION WILL BE EMAILED)

* 4. ALTERNATE EMAIL (OPTIONAL)

* 5. ADDRESS

* 6. CITY

* 7. PROVINCE

* 8. POSTAL CODE

* 9. HOME PHONE 

* 10. MOBILE PHONE (FOR EMERGENCY NOTIFICATION)

* 11. PRIMARY WORK PHONE 

* 12. PRIMARY EMPLOYER

* 13. Amount of Payment

* 14. Method of Payment

* 15. I understand that handout material cannot be reproduced (in whole or in part) without permission from Critical Care Concepts.  I am also aware that access to online course material is restricted to registered participants. 

* 16. Course content is provided for educational purposes only. Critical Care Concepts assumes no responsibility for the application of content in the clinical area or for the clinical decision-making of any participant. 

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