Register for Membership

Membership is free and available to qualified Movement Disorder Professionals in Canada.

Name *

First

Last

Professional Affiliation *

Clinic or Clinical Program / Hospital or Academic Institution

City *

Province *SelectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecYukon

Email *

Profession *

• Neurologist
• Neurosurgeon
• Physician Other Specialty (please specify below)
• Surgeon Other Specialty (please specify below)
• Nurse
• Physiotherapist
• Occupational Therapist
• Speech & Language Therapist
• Psychologist
• Social Worker
• Dietician
• Non-Clinician Scientist
• Other

Other Professional Specialties

What is your professional relation to the Movement Disorders sub-specialty? *

Do you have any specific interest within the Movement Disorders sub-specialty? *

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