Annual Conference 2023

Full Name*

PrefixFirst NameLast Name

How would you like your name to appear on your conference name badge?*

(Example: Dr. John Smith)

Please read: Canadian Physicians for Life Statement of Principles*

I agree with Canadian Physicians for Life’s Statement of Principles. *CPL members donate funds to facilitate the attendance of pro-life medical students and residents to the conference.I am not in agreement with Canadian Physicians for Life’s Statement of Principles.

College/University

Grad Year

Area of Specialty (if a resident)

Area of Specialty (if a physician)

Sex (only required for hotel room reservations for scholarships)

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Please list any dietary restrictions you have*

If there are other applicants with whom you would like to share a room, please list their names

(otherwise, in the case of hotel accommodation, we will assign room mates, 2 persons per room)

How did you hear about CPL’s 2023 Annual Pro-Life Conference?*

Please list the name of a past CPL Conference attendee, a Canadian Physicians for Life member, or a conference speaker who can speak to your interest in pro-life issues and bioethics. If you do not know of someone who can do so, that is not prohibitive to your participation at the conference. It does however facilitate the administration of sponsorships.

Have you ever attended one of Canadian Physicians for Life’s conferences in the past?*

YesNo

If so, what did you find most valuable from the experience?

If not, what are you hoping to gain from attending CPL’s conference this year?

Requirements and conditions for sponsorship recipients:

Canadian Physicians for Life will sponsor as many medical students to attend this event as possible, funds permitting.

Canadian Physicians for Life will pay for:

2 nights, shared accommodation at the Delta Hotel Ottawa Centre for out-of-town students. CPL will reserve your room.
Conference fees and meals.
A maximum allowance for air/train/bus/car travel, depending on location person is travelling from (exact amounts to be determined).

Students will be required to pay any remaining costs including the following:

The portion of the travel fare over the maximum allowance. Students receiving a scholarship will be responsible for booking and paying for their flights (or other means of transportation) and will be issued a cheque reimbursing them for the travel expenses up to the maximum allowance by November 30, 2023.
Students are required to submit their travel receipts, a donor thank you note, and their Event Survey in order to receive the reimbursement.
Students are encouraged to be on the lookout for seat sales, which can reduce the cost of a flight considerably. Seat sales come and go all the time, so vigilance is recommended in order to get the best deal possible. Google Flights and Hopper.com are good resources.
Transportation between airport and conference location.

Other details:

Sponsorship recipients are required to attend all sessions.
Sponsorship applicants must complete the essay question.
Receipt of application will be acknowledged via email. If you have not received an acknowledgment within a few days of sending in your application, please contact Natasha.
Selection of scholarship recipients will commence before the deadline date, so applicants are encouraged to send their applications in as soon as possible. Space and funding are limited.

Requirements Agreement*

I agree to these requirements and conditions for sponsorship.

Essay Questions

Please briefly answer (500 words or less) the essay question below:

Which recent class, news story, or circumstance has most impacted or challenged your pro-life ethic and perspective? How did you react or approach the situation? What was the outcome, if applicable?

Membership

I’d like to receive information about becoming a member of Canadian Physicians for Life (medical students can join CPL as members).

To apply for membership, please fill out this form. [Membership is free]

Monthly Donor

I’d like to receive information about becoming a monthly donor.

Conference Sponsorship

I’d like to donate to the student sponsorship fund. [A CPL staff member will follow-up with you to process your donation. A full student sponsorship is $1100.00.]

Registration Payment

Full Conference $597.00CAD

Full access: 10 sessions, Friday and Saturday night dinners and socials, Saturday and Sunday breakfast and Saturday lunch plus coffee breaks. Access to videos after the conference.

Friday Only $175.00CAD

Dinner, Keynote Speaker Dr. Xavier Symons and Social

Saturday Only including Banquet$397.00CAD

6 sessions, Breakfast, Lunch, Coffee Breaks and Banquet with Dr. Kristin Collier

Saturday Only - No Banquet$225.00CAD

5 sessions including Dr. Aasim Padela, Breakfast, Lunch, Coffee Breaks

Saturday Evening Banquet Only$175.00CAD

An evening shared with friends. Awarding of the Paul Adams award. Keynote address given by Dr. Kristin Collier

Sunday Only $125.00CAD

3 sessions including Mark Meincke plus Breakfast and Coffee Breaks

Friday and Saturday (including Banquet)$547.00CAD

7 sessions plus all meals.

Saturday (including Banquet) and Sunday$497.00CAD

9 sessions plus all meals

Online Full Conference$197.00CAD

Join Us in Real-Time for Live Online access and video access after the conference.

Enter coupon

Total $0.00CAD

During conference activities, a videographer may be recording footage and/or a photographer may be taking casual photographs. These digital assets belong to Canadian Physicians for Life (CPL) and may be used by CPL for educational and promotional purposes, such as CPL publications and social media, and on the CPL website. Your registration confirms your permission to be videoed and/or photographed, and have your image/video included in these promotional assets.

Please note: Registrants are responsible for making their own hotel reservations. The room block reservation date has now passed, however we still have some rooms available directly through CPL. Please reach out to Natasha at office@physiciansforlife.ca

Payment Note: Registration payments are accepted through PayPal but you do not require a PayPal account to pay. Please reference the screenshot below for what to expect when you submit your form for payment.

You will be redirected to PayPal to process payment and can choose to return to Canadian Physicians for Life after payment has been processed. PayPal is secured through a security certificate to ensure all information sent and received is encrypted, ensuring your privacy and protection.