Program Application "*" indicates required fields ACPAC 2026-2027 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 Designations*Year 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 Optional Preparatory CoursesPlease indicate which of the following preparatory 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 Rheumatology Bootcamp 101: Assessment & Management of Rheumatic Disease Date Rheumatology Bootcamp 101 completed An equivalent course to the above Equivalent course name and date completed None of the above Planned Course I have registered for an upcoming program Name and scheduled date This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
