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Conference Registration "*" indicates required fields Name* First Last Email* Enter Email Confirm Email Billing Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code PhoneWould you like to host a Jeff Cavins Local Guild Event? Yes Workshop Selection* Resilience in Residency - Mimitha Puthuparampi Truth and Beauty: Incorporating Natural Family Planning into an Evidence-Based Practice - Stephanie Kafie Joyful Conscience in the middle of Trials and Perseverance - Nicole Scheidl Medical Decisions in Extraordinary Times: Applying the Lessons of the COVID-19 Pandemic - Lucas Vivas God in the Exam Room - David Chan Are you a Member of the Federation?* Yes No Unknown Do you wish to Renew or Upgrade your Membership?*Conference discounts applied automatically with upgraded membership Yes No Do you wish to become a Member?* Yes No Local Guild MembershipPlease select your Local Guild* ✓ Your local guild amount will be added to the total amount below and will go directly to your guild ✓ All membership payments are for the current fiscal year.Please selectCalgary - $20Halifax - $50Edmonton - $50HamiltonKingston - $50MontrealOttawaQuebec City - $50Red Deer - $50Sarnia - $50Saskatoon - $50TorontoVancouverVancouver Island - $50Already Paid to Local GuildIndependent - No Local GuildHamilton Guild - please select Category*Please selectPhysician - $50Other Healthcare / Resident - $40Student - $20N/AOttawa Guild - please select Category*Please selectPracticing Physician - $150Retired Physician - $75Associate Member - $50Resident - $20Student - $0N/AMontreal Guild - please select CategoryPlease selectPhysician - $50Student - $10N/AToronto Guild - please select Category*Please selectPhysician - $50Resident/Student - $25N/AVancouver Guild - please select Category*Please selectPracticing Physician - $100Retired Physician - $50Student/Resident - $10N/AFederation MembershipPLATINUM membership gets you: ✓ 50% off annual conference fee ✓ Opportunities for direct consultation with the president and executive ✓ Special thank you reception and gift at our annual conferenceGOLD membership gets you: ✓ 25% off annual conference fee ✓ Opportunities for direct consultation with the executive ✓ Special thank you reception at our annual conference Please select your Membership Type* Platinum - $1000 Gold - $750 Silver - Physician Membership - $100 Silver - Retired Physicians/Residents - $75 Silver - Affiliated Membership - $50 Students (FREE) - $0 Conference FeesPlease select Conference Fee*Please selectPhysician - $350Resident/Retired - $275Student/Clergy - $0Affiliated/Academic - $265Please select Conference Fee*Please selectPhysician - $300Resident/Retired - $225Student/Clergy - $0Affiliated/Academic - $215Please select Conference Fee*Please selectPhysician - $150Resident/Retired - $112.50Student/Clergy - $0Affiliated/Academic - $107.50Please select Conference Fee*Please selectPhysician - $225Resident/Retired - $168.75Student/Clergy - $0Affiliated/Academic - $161.25TotalsMembership Total Price: $ 0.00 CAD Conference Fees* Price: $ 15.00 CAD TOTAL Credit CardCard Details Cardholder Name
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