NLMA Forms
Buprenorphine/Naloxone Treatment of Addiction Program Registration Form

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Instructions Use this form to register for the Buprenorphine/Naloxone Treatment of Addiction Program.

Registrant (NLMA Members ONLY)

Name

NLMA Number

Badge Name

Badge Title

Diet/Allergies

Registrant (Non-NLMA Members ONLY)

Name

Organization

Job Title

E-mail

Badge Name

Badge Title

Diet/Allergies

Registration

Registration*

Date
Registration closed November 2 (Corner Brook)
December 1 (Carbonear)

Notes

Requests/Questions


(*required)

Policies
Deadline
Registration closes 5 pm on Wednesday, October 31 (Corner Brook); and, Wednesday, November 29 (Carbonear).
Cancellation Cancellations received by October 31 (Corner Brook) and November 29 (Carbonear) will receive a full refund less a $25 cancellation fee. There will be no refunds for cancellations received after the close of registration due to catering commitments.


Assistance For assistance, please contact Martha Muzychka at martha.muzychka@gmail.com.

Newfoundland and Labrador Medical Association
NLMA House, 164 MacDonald Dr., St. John's, NL, Canada, A1A 4B3
Telephone (709) 726-7424 | Toll Free (800) 563-2003 | Fax (709) 726-7525
E-mail nlma@nlma.nl.ca | Web www.nlma.nl.ca