Title:  
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(For family physicians, first and last name should match your CFPC membership)
Last Name:*  
Email:  
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Province of Practice:*   
City of Practice:*  
Profession:*      
Years in Practice:*   
Percentage of time spent practicing obstetrics:  
Primary practice location:*      
Primary practice setting:*   
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(*) These fields are mandatory
(**) Access to the Contemporary Topics in Early Antenatal Care course is provided for a period of 6 months


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