Educating Family Physicians in Palliative Care - Fall 2025

Family Physician Registration Deposit

Contact Information:

* Denotes a mandatory field
*First Name:
*Last Name:
*Title:
* Company/Organization:
Mailing Address:
City:
Province/State:
Country:
*Postal/Zip Code:
*Telephone:
Extension:
*Email Address:

Event-Related Questions

*I would like to receive notification about programs through the CPD newsletter
*How did you hear about the program?
If other, please specify
*I understand that the deposit of $325 will be retained if I do not attend the program, and additional fees will apply to professions other than family physicians, as the Ministry funding is only provided for eligible family physicians in the approved pra
Yes
*Are you aware that this program is for Family Physicians living within the areas of Kingston, Frontenac, Lennox and Addington, Hastings, Prince Edward, Lanark, Leeds and Grenville, Northumberland, Haliburton, Peterborough, Victoria, and Durham and if you
Yes
*Are you a Family Physician in Ontario?
*If no, please specify (enter N/A if you are an FP)
*In what area do you practice?
*I understand that all four tasks (4-day program, pre-program knowledge assessment, post-program reflection and assessment and the preceptorship) must be completed in full in order to receive the Mainpro+ certificate for this program.
Yes
In order to better address your learning needs, please identify three practice questions you have pertaining to the topic of this CPD event. These questions will be provided to speakers in order to inform the content of their sessions.
Please let us know if you have any dietary restrictions or preferences that we should be aware of for catering purposes.
We’re committed to making our programs inclusive and accessible. Using the space below, please indicate any accommodations you may need—such as for nursing, faith-based observances, or accessibility—to fully participate.
*Queen's University's Collection Notice
Personal Information is collected under the authority of the Queen’s University Royal Charter, 1841 , as amended, 
and will be used for the registration and associated uses for attending/registering for Educating Family Physicians in Palliative Care - Fall 2025. 
Questions regarding the collection or use of this personal information should be directed to cpd.team@queensu.ca. 

By clicking 'Yes' you agree to the collection of this information.
yes

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