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AHPA Pre-Course Waitlist

As our Pre-course space is limited please complete the form below. You will be placed on a waitlist based on receipt of request to attend the course. No further funding bursaries are available for attendance of the pre-course.

You will receive notification of your successful application via e-mail.

Name:
Address:
City:
Province:
Postal Code
Institution/Program
Office Number:
Fax:
E-mail Address:
Discipline within Rheumatology:
Preferred Language for future communication
Primary Rheumatologist you work with: