If you are human, leave this field blank.

CONFERENCE REGISTRATION

First Name *

Last Name *

Affiliation/Organization

Job Title

Address *

City/Town *

Province *

ABBCMBNBNLNSNTNUONPEQCSKYT

Postal Code *

Email *

Phone *

Dietary Requirements (check all that apply)

Gluten-Free

Vegetarian

Vegan

Food Allergy

Please List Food Allergy:

Demographic Information (Optional)

By completing the section below, you help make sure our programs reach the entire community and report accurate numbers back to our funding partners, ensuring continued annual support. All information is kept confidential and is anonymously combined prior to reporting to other organizations.

Self Declaration

Indigenous

Immigrant/Refugee

Disability

Single Parent Family

Age

7-17

18-21

22-29

30-54

55-64

65+

Conference Fees

Registration - Early Bird Pricing available until July 31st.

Early Bird Regular 2-Day: $380.00

Early Bird Member* 2-Day: $345.00

Early Bird Student**/ Volunteer*** 2-Day: $270.00

Regular 1-Day: $235.00

Member* 1-Day: $215.00

Student**/ Volunteer*** 1-Day: $165.00

If using Student/ Volunteer Registration rates, please upload your proof of status or Letter of confirmation of hours from Volunteer Coordinator.

Proof of Student**/Volunteer*** Registration

Concurrent Session Choices

Please select which concurrent sessions you will be attending. If you are registering for 1 day, please select the option that you will not be attending a concurrent session.

Concurrent Session Block A

Thursday, September 21 - 10:00 AM

A1: Queering Palliative Care IA2: Family Physicians Supporting Patients with Palliative Care Needs within the Patient Medical Home in the CommunityA3: Psychedelics in Palliative CareNot Attending Thursday

Concurrent Session Block B

Thursday, September 21 - 11:15 AM

B1: Queering Palliative Care IIB2: Talking about Death in the Community and Communicating CareB3: Trauma Informed Practice in Palliative CareNot Attending Thursday

Concurrent Session Block C

Thursday, September 21 - 1:15 PM

C1: What is the Meaning of Life...and Other Unhelpful QuestionsC2: Palliative Care at the Portage District General HospitalC3: Help! My Palliative Care Patient is Allergic to OpioidsNot Attending Thursday

Concurrent Session Block D

Friday, September 22 - 10:00 AM

D1: Paramedics Providing Palliative Care in The HomeD2: The Impact of COVID-19 Visitor Restrictions on the Health Care Team of a Palliative Care UnitD3: Lung Cancer Management Overview for the Palliative CareNot Attending Friday

Concurrent Session Block E

Friday, September 22 - 11:15 AM

E1: The Early Palliative Care TeamE2: A Deep Dive into Clinician SufferingE3: Alternate Routes of Medication Administration Not Attending Friday

Concurrent Session Block F

Friday, September 22 - 1:15 PM

F1: Caregiving & Grieving During the COVID-19 PandemicF2: Exploring Psychiatric Nursing Practice in End-of-Life CareF3: Hypercalcemia in Cancer and Palliative CareNot Attending Friday

ONCE YOU CLICK SUBMIT: *

Your form will be submitted and you will be redirected to CanadaHelps.org to proceed with payment. You are not registered for the conference until your payment is received.

I Understand

IF SENDING IN A CHEQUE:

Please click this option if you are filling out the form and mailing a cheque. Cheques payable to Palliative Manitoba indicating attendee’s name.

I am Mailing a Cheque

Submit

*Maximum two delegates per Palliative Manitoba Association Member, as authorized by member contact. **Rates for full-time students only. Proof of full-time student status is required with registration form. ***Letter from a Regional/Volunteer Coordinator verifying 24 hours of volunteer service in palliative care over the last 12 months is required with registration form. Refunds subject to $40 processing fee. No refunds after September 8th. $10 fee for registrations received after September 8th.