May 19, 2012

Alberta Hospice Palliative Care Association

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You are here: Home / Events / AHPCA Workshops / Current / 2012 Roadshow / Airdrie, AB

Airdrie, AB

Talking About the Tough Stuff
Airdrie, AB

Date: October 3, 2012

Time: 9:00am - 3:30pm

Cost:

AHPCA Members $10.00

Non Members $55.00 (includes AHPCA/CHPCA membership to March 31, 2013)

Please fill out the fields below to register
Your Position
- Volunteer
- Doctor
- Nurse
- Social Worker
- Other
Name*
FirstLast
Address*
Street AddressAddress Line 2CityProvincePostal Code
Phone*
Enter your phone number (123)456-6789
Email*
Please enter a valid email address so we can notify you of any workshop changes.
Are you currently an AHPCA member?*
- YES
- NO
- Former Member
Roadshow Registration includes a joint membership to the Alberta Hospice Palliative Care Association and the Canadian Palliative Care Association.

Cost: $55.00

Membership is valid until March 31, 2013
If you are unsure about the status of your membership please call our office at (403) 206-9938 or email jennifer.ahpca@telus.net

Roadshow Registration includes a joint membership to the Alberta Hospice Palliative Care Association and the Canadian Palliative Care Association.

Cost: $55.00

Membership is valid until March 31, 2013
How will you be paying*
- Online with Credit Card
- Mail in Cheque & Registration Form
- Mail in Credit Card & Registration Form
- Fax in Credit Card & Registration Form
Please choose which payment option you will be using. Choose only one.
Please complete these additional fields below
AHPCA Newsletter (What's Happening?) and CHPCA Newsletter (AVISO) sent by email?*
- YES
- NO
AHPCA Newsletter (What's Happening?) and CHPCA Newsletter (AVISO) sent by email?*
- YES
- NO
Join CHPCA Interest Groups
- Aboriginal Issues
- Complementary/Integrative Therapies
- Long Term Care/Continuing Care
- Pediatric Issues
- Pharmacists
- Physiotherapists
- Rural and Remote Issues
- Social Workers/Counsellors
- Spiritual Advisors
- Volunteer Issues
Please check the box(es) of the free Interest Groups of which you wish to become a member.
Join CHPCA Interest Groups
- Aboriginal Issues
- Complementary/Integrative Therapies
- Long Term Care/Continuing Care
- Pediatric Issues
- Pharmacists
- Physiotherapists
- Rural and Remote Issues
- Social Workers/Counsellors
- Spiritual Advisors
- Volunteer Issues
Please check the box(es) of the free Interest Groups of which you wish to become a member.
Join CHPCA Nurses Interest Group
- Nurses Interest Group
If you are Nurse you may be interested in joining the Canadian Hospice Palliative Care Association Nursing Interest Group for an additional $20.00 per year.
Join CHPCA Nurses Interest Group
- Nurses Interest Group
If you are Nurse you may be interested in joining the Canadian Hospice Palliative Care Association Nursing Interest Group for an additional $20.00 per year.
Roadshow Registration with New Membership
Price: $ 55.00 CAD
Roadshow Registration with New Membership
Price: $ 55.00 CAD
If you were a member and are sure of the status of your membership please contact our office at 403-206-9938 or email ahpca@telus.net
Roadshow Registration - Existing Membership
Price: $ 10.00 CAD
Total Cost
$ 0.00 CAD
Note: Click submit to access the printable form to fax or mail
Note: Click submit to continue to payment page on the Secure PayPal Payment site.

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