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Faculté de médecine
DPC Formulaire de proposition d’un programme
Titre
Titre
Titre
- Aucun(e) -
Mlle
Mme
M.
Mme
Dr ou Dre
Autre...
Enter other…
Prénom
Deuxième prénom
Nom de famille
Département
Campus
Tél. (C)
Téléphone
Type
- Type -
Résidence
Bureau
Cellulaire
Téléphone
Ext:
Address courriel
Address courriel
Confirmer l'e-mail
Est-ce que vous remplissez ce formulaire au nom du demandeur?
Oui
Non
Full Name
Position
Phone Number
Program Details
Program Title
Name of the Chair of the Program Planning Committee (if available)
Name of Department Chair
Name of the Organization(s) Developing the Program
Estimated Number of Registrants
Start date of the Program
End date of the Program
Is this day flexible?
Yes
No
Please enter your preferred months and restrictions
Length of program
How will this Activity be funded?
Registration Fee
Department Grants
Commercial Sponsor Grants
Autre...
Enter other…
Please Select the Type of the Program
|In-person Conference
Webinar and E-Learning
Virtual Conference
Hybrid Conference (in-person conference with a virtual components)
Simulation
Live surgeries
Social Event (ex. Reception, dinner)
Target Audience
Family Physician
Specialist
Allied Health Professional
Resident/Fellows
Autre...
Enter other…
If the conference runs a deficit, how will the course management fees and other course expenses be covered?
CPD Support
Select what kind of support you my need from the Office of CPD
Logistics Management (Venue, Catering, AV)
Accreditation
Planning Meetings
Sponsorship
Advertising and Marketing
Registration Services
Program Evaluation
Abstract Management
Speaker Management
Financial Management
Choose what type of accreditation you need
RCPSC Section 1 (Group Learning)
RCPSC Section 3 (Self-Assessment or Simulation Programs)
CFPC Mainpro+ (Group Learning)
Autre...
Please Specify
Laisser ce champ vide