WRITTEN COMPONENT WORKSHOP (MCQ) REGISTRATION

Workshop Date:*

June 7 - 18, 2021

Name*

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Gender*

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Date of Birth*

Email*

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Cell Phone*

Country of PT Education*

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Intending to take Alliance OSCE exam

Confidentiality Agreement*

I have read and understood the registration confidentiality agreement, and by checking the box below indicates that I agree not to disclose any information regarding the content of the Exam Skills Preparation Workshop and agree to the following Rules of Conduct: 1. I understand that the content of the Exam Skills Preparation Workshop is confidential. 2. I acknowledge that the examinations that are a part of the Exam Skills Preparation Workshops are the exclusive property of the University of Toronto. 3. I understand that no examination training material may be duplicated without permission of the University of Toronto. 4. I acknowledge that I can remove no part of the Exam Skills Preparation Workshop materials from the test site, nor can I give or receive clinical information about the materials either before or after the workshop. 5. I will ensure the confidentiality and security of the Exam Skills Preparation Workshop materials.

Confidentiality Agreement*

I understand and agree with the above confidentiality agreement and rules of conduct.

Date*

Workshop Fee*

Price: $ 200.00 CAD

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Written Component Workshop (MCQ) Registration Form