2018 Annual Conference

2019 Annual Conference

October 25 - October 27, 2019

Ottawa, Ontario
General registration closes October 18^th. The sponsorship application deadline is October 11^th, but sponsorships are granted on a first-come basis, so register early.
Registering as*

I am a physician or retired physicianI am a friend of CPL (I am not a physician or medical student)I am a student or resident NOT seeking financial aid and sponsorshipI am a student or resident seeking financial aid and sponsorship

(Please note that student sponsorship is not guaranteed and all the requirements for the sponsorship application process must be completed, submitted, reviewed and accepted by CPL staff.)
Please Note: Students are not guaranteed a spot until all details of the registration process have been confirmed.

Full Name*

PrefixFirst NameLast Name
How would you like your name to appear on your conference name badge?*
(Example: Dr. John Smith)
I am a*

PhysicianRetired PhysicianAssociate Member of CPLFriend of CPL (I am not a physician or medical student or associate member)Student not seeking financial aidResident not seeking financial aid
I am a*

Student seeking sponsorshipResident seeking sponsorship
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.
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.
Medical School
Grad Year
Area of Specialty (if a resident)
Area of Specialty (if a physician)
Sex*

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 or 3 persons per room)
“Dinner with a Doctor” Pre-Conference Networking and Mentorship Dinner

Please register me for the “Dinner with a Doctor” event.
"Dinner with a Doctor" is a pre-conference event at the hotel restaurant. Your conference fee does not cover the meal for this event. A special menu at a reduced price.
How did you hear about CPL’s 2019 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 Brookstreet Hotel 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 20, 2018.
- 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 Beth.
- 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 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 student can join CPL as members).
For more information on becoming a member please visit our website.
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. (Online donations may be made here or a CPL staff member will contact you to follow up.)
The early bird registration rate is $395 until July 15, 2019. After that date the General Registration is $495.

Please note: Registrants are responsible for making their own hotel reservations. More details available on the conference web page.
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.
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2019 Annual Conference

Essay Questions