**This symposium is accredited for 3.5 RCPSC MOC Section 1 credits**

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* 1. Family Name

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* 2. First Name

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* 3. Profession

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* 4. CMQ License # (required for MDs only)

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* 5. Division

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* 6. Site

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* 7. Email Address

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* 8. Will you be attending in-person or by Zoom?

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