Register for Membership

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

FIRST NAME

LAST NAME

PROFESSIONAL AFFILIATION *

CITY *

PROVINCE *AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuébecSaskatchewanYukon

EMAIL ADDRESS *

PROFESSION *NeurologistNeurosurgeonPhysician Other Specialty (please specify below)Surgeon Other Specialty (please specify below)NursePhysiotherapistOccupational TherapistSpeech & Language TherapistPsychologistSocial WorkerDieticianNon-Clinician ScientistOther (Please enter below)

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? *

SUBMIT

Please do not fill in this field.