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CMSA Workshop: January 2026
Please note: Participant seats are limited. Submitting this form does not confirm your registration. An email will be shared at a later date to confirm your registration.
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1.
First Name (
Please register with the name you would like to appear on your certificate)
(Required.)
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2.
Last Name
(Required.)
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3.
Email address (organization emails preferred)
(Required.)
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4.
Profession
(Required.)
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5.
Organization
(Required.)
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6.
Part of the continuum (e.g. acute, inpatient, outpatient, etc.)
(Required.)
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7.
What percent of your time do you work in stroke?
(Required.)
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8.
I have discussed and received approval for the time commitment required for this workshop with my manager:
(Required.)
Yes
No
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9.
Please provide your manager's email address:
(Required.)
10.
Indicate any food allergies or dietary restrictions: