Program Application "*" indicates required fields ACPAC 2025-2026 Program ApplicationName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Email (Primary)* Home Phone*Home Fax(if applicable)Cell PhoneAddress* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code How did you hear about the ACPAC program?*Institution / Workplace DetailsInstitution NameAddress Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Business PhoneBusiness Phone ExtensionBusiness FaxProfessional InformationInstitution from which Professional Degree was issuedProfessional DesignationsYear of Graduation0 of 4 max charactersPrimary Administrative ContactInstitution / WorkplaceName Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Admin PhoneAdmin ExtensionAdmin Email Admin Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code PrerequisitesPlease indicate which of the following prerequisite courses you have completed: Clinical Practice Skills for Inflammatory Arthritis (CPSIA) program offered by the Arthritis Society Date CPSIA program completed Assessment and Management of Rheumatic Diseases: A skills workshop offered by the ACE Program Date Assessment and Management of Rheumatic Diseases completed An equivalent course to the above Equivalent course name and date completed None of the above CPSIA Course I have registered for an upcoming CPSIA course This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
