JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Event registration
Event Timing: March 25, 2022: 8:00am - 4:00pm
Event Address: Zoom
Contact us at
dime@uottawa.ca
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full name (first and last)
*
Your answer
Phone Number
*
Your answer
Title
*
Choose
Dr.
Mr.
Mrs.
Ms.
Mx.
Profession
*
Choose
Fellow
General public
Medical student
Non healthcare professional
Other healthcare professional
Masters student
PhD student
Physician
Resident
uOttawa faculty
uOttawa support staff
Other (n/a)
Organization
*
Choose
Medical Council of Canada
Royal College of Physicians and Surgeons of Canada
The Ottawa Hospital
University of Ottawa
Other
Faculty
*
Choose
Education
Medicine
Other (n/a)
Department / School / Program
*
Choose
BMI
CMM
DIME
SEPH
Anesthesiology and Pain Medicine
Emergency Medicine
Medicine
Family Medicine
Obstetricts, Gynecology and Newborn Care
Ophthalmology
Otolaryngology-Head & Neck Surgery
Pediatrics
Pathology & Laboratory Medicine
Psychiatry
Diagnostic Radiology
Surgery
CPD
Faculty Affairs
Graduate and Postdoctoral Studies
PGME
UGME
Research Office
TMM
IGHO
Other (n/a)
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms