CanREACH PPP Mini-Fellowship

CanREACH PPP Mini-Fellowship
***Please Note***CanREACH gives priority to residents of Alberta. If you do not practice in Alberta, please do not complete the payment process. We will be in contact with you to discuss availability once you have submitted this form.
NAME *

First Name Last Name
AREA OF PRACTICE *
COMPLETE MAILING ADDRESS FOR COURSE MATERIAL DELIVERY- please include postal code *
PRIMARY CARE NETWORK AFFILIATE *
ALBERTA HEALTH SERVICE ZONE *
Phone Number *

Area Code Phone Number
E-MAIL *
REGISTERING BODY *
PREFERRED SESSION DATE AND LOCATION

CanREACH Virtual - September 2021 - March 2022 (Conference date: September 10-12 2021) CanREACH Virtual - October 2021 - April 2021 (Conference date: October 22-24 2021)
Please note that the January 2021, February 2021 and May 2021 cohorts are full.
HOW DID YOU HEAR ABOUT US? *
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