Registration Form

Registration Fees
Seating is limited. Open to physicians only.

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

Physician - $149.00 plus HST
Early Career Physician* - $99.00 plus HST
Resident - $99.00 plus HST

*in practice less than 5 years

Registration Details
Salutation    
First Name  
Last Name  
Profession *  
If Specialist, specify:    
Address 1  
Address 2    
City  
Province *  
Country *  
Postal Code  
Phone  
Email  
Years in Practice  

Special Dietary Requirements:
If Allergy or Other, please specify

Payment Details




Total Payment: $

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's Dermatology Leadership Meeting 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 location, 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
All registration fees will be refunded less a $50.00 + HST administration fee for refund requests received prior to Friday, April 13, 2018. No refunds will apply for cancellations received after this date.

Communication Consent