When Kids Seize:
What to Recognize, When to Worry, and How to Treat

Paediatric Epilepsy CME Education Dinner Event
October 28, 2026 | 6:00 - 9:00 PM | Unionville, Markham, ON

Thank you for your interest in our event: When Kids Seize: What to Recognize, When to Worry, and How to Treat - Paediatric Epilepsy CME Education Dinner Event.

Date: October 28, 2026
Time: 6:00 - 9:00 p.m.
Venue: Next Door Restaurant | Unionville, Markham, ON

The registration form takes approximately 5-minutes to complete. Please ensure all required information is provided to avoid delays in confirming your attendance. We look forward to welcoming you!

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1. What is you first and last name ? (Required.)

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2. What is your email address (Please ensure to review spelling prior to clicking submit) ? (Required.)

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3. What is your Primary Clinical Role ? (Required.)

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

PGY 1

PGY 2

PGY 3

PGY 4

PGY 5

Clinical Epilepsy Fellow

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. Please provide details about the primary clinic or hospital? (Required.)

Name

City

Postal Code

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7. Please indicate your 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?
***We will do our best to accommodate your dietary needs and restrictions.* (Required.)

Yes (please specify)

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9. Do you require financial assistance to attend this event ? This support may include coverage for accommodation, parking, and/or transportation. However, availability is limited and not guaranteed. We will do our best to accommodate your needs. ONLY available to healthcare providers. (Required.)

Yes

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10. Do you have any accessibility requirements that we should be aware of to help ensure your comfort and full participation during the event?

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11. I agree that printed case materials are available by request. I understand that they will be provided on the day of the event and must be returned afterward. Also, that electronic copies will not be provided due to case sensitivity, and that all materials will be presented on screen. (Required.)

Agree

Disagree

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12. Thank you for completing the registration form. Please read the disclaimer below. We will do our best to accommodate your needs for this event. (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 at least 72 hours in advance if I am unable to attend the event.

When Kids Seize: What to Recognize, When to Worry, and How to TreatPaediatric Epilepsy CME Education Dinner EventOctober 28, 2026 | 6:00 - 9:00 PM | Unionville, Markham, ON

Question Title

* 1. What is you first and last name ? (Required.)

Question Title

* 2. What is your email address (Please ensure to review spelling prior to clicking submit) ? (Required.)

Question Title

* 3. What is your Primary Clinical Role ? (Required.)

Question Title

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

Question Title

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

Question Title

* 6. Please provide details about the primary clinic or hospital? (Required.)

Question Title

* 7. Please indicate your 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?**We will do our best to accommodate your dietary needs and restrictions. (Required.)

Question Title

Question Title

* 10. Do you have any accessibility requirements that we should be aware of to help ensure your comfort and full participation during the event?

Question Title

Question Title

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

When Kids Seize:
What to Recognize, When to Worry, and How to Treat

Paediatric Epilepsy CME Education Dinner Event
October 28, 2026 | 6:00 - 9:00 PM | Unionville, Markham, ON

1. What is you first and last name ? (Required.)

2. What is your email address (Please ensure to review spelling prior to clicking submit) ? (Required.)

3. What is your Primary Clinical Role ? (Required.)

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

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

6. Please provide details about the primary clinic or hospital? (Required.)

7. Please indicate your primary practice setting (please select the option that best describes your practice setting). (Required.)

8. Do you have any allergies or dietary restrictions?
***We will do our best to accommodate your dietary needs and restrictions.* (Required.)

10. Do you have any accessibility requirements that we should be aware of to help ensure your comfort and full participation during the event?

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