Registration Form

Registration Type
Seating is limited. Exclusive to CDA Members.

An automatic email confirmation will be forwarded immediately following completion of your registration.




Total Payment: $

Registration Details
Salutation    
First Name  
Last Name  
Registration Type *  
Address 1  
Address 2    
City  
Province *  
Country *  
Postal Code  
Phone  
Email  



Emergency Contact Information:
Name  
Primary Phone Number  
Relatoinship to delegate  

Terms and Conditions of Registration
1. It is agreed that the Canadian Dermatology Association (CDA), its employees, directors, officers, volunteers, contracted staff, contracted companies and agents shall not be held liable or responsible for any loss or damages, however caused by any person engaged by, participating in, or attending the Women in Dermatology Leadership Conference for any reason, no matter how caused.

2. It is agreed that the CDA, its employees, directors, officers, volunteers, contracted staff, contracted companies and agents reserve the right to limit or refuse admission, cancel or reschedule programs, change speakers, or revise content at any time. Decisions regarding the necessity for such decisions shall be taken by the CDA or its agents at their sole discretion and shall be final.

3. It is agreed that the CDA, its staff, contractors and agents may use my personal information to prepare for my participation in this event, and that any photographs or recordings made of me by the CDA, its staff, contractors and agents during the program may be used by the CDA at a later date for advertising, publicity, commercial or other business and/or educational purposes.

I Consent

Cancellation Policy
Registration fees for the Women in Dermatology Leadership Conference are non-refundable.