An Afternoon of Dermatology 2025

PHYSICIAN Fee - An Aftenoon of Dermatology

Contact Information:

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*First Name:

*Last Name:

*Title:

* Company/Organization:

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*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 this program is designed for Family Physicians and that as a Nurse Practitioner I am not eligible to complete the preceptorship nor receive any financial support to cover expenses.

Yes

*What is your profession?

Profession - Additional Information

*In what geographical location (City, Province) do you practice?

*Are you an employee of a pharmaceutical company, device manufacturer, or other commercial interest that poses a potential for bias with regard to the program content?

If you answered yes, please supply your title and company

* I consent to have my information shared with the program sponsors so that they can provide me with periodic follow-ups on product updates and developments, patient support materials, and educational events.

Please list any dietary restrictions, preferences, or allergies we should consider when planning meals."

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.

In order to better address your learning needs, please identify three 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 confirm that you understand the following policies: If you can cancel your registration with less than 48 hours’ notice, a cancellation fee of $90.00 will be retained.

Yes

*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 An Afternoon of Dermatology.
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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