You must have JavaScript enabled to use this form. Contact information First name Last name Phone (Please format your phone number with +1 at the start. Example: +1 519-646-6100): Type - Type -HomeOfficeCell Phone Ext: Email Organization: Mailing Address: Role: - Select -OTPTCHTKinesiologistStudent OT/PTOT/PTPT/CHTCHT/OTOther Other Role (please enter): Breakout Sessions: Please indicate your breakout session preference for each day by selecting either 1 or 2: 1 = First choice and 2 = Second choiceBreakout sessions will be assigned based on your preferences and session capacity. Every effort will be made to accommodate your first-choice selection whenever possible. Assignments will also be made on a first-come, first-served basis, subject to availability Friday, November 6, 2026 EMG + Biofeedback Wound Management Saturday, November 7, 2026 Cadaver Lab Splinting/Orthosis Lab Please include any dietary restrictions: Details: Vegan Gluten Free Other: Please list foods that trigger an allergic reaction or other dietary needs: Registration Select registration type: Early Bird Full conference Registration (ends Oct. 9): $550 Student Full Conference Registration Fee: $400 Early Bird One Day (ends Oct.9): $300 If registering for one day only, please indicate the date you will attend: - Select -November 6, 2026November 7, 2026 Payment type Online payment by credit card - to complete your registration, please proceed with payment by credit card through Paypal by selecting the "Submit" button below. This personal information is being collected under the authority of the Public Hospitals Act R.S.O. 1990, CHAPTER P.40 for the purpose of contacting the sender in response to an inquiry. If you have questions about the collection of this information, please contact Privacy and Freedom of Information, St. Joseph's Health Care London, 268 Grosvenor Street, London, ON,519-646-6100 ext. 65591.
