Registration

Title:
First Name:
Last Name:
Year of birth:   ex:1956
Sex:
Institution:
Department:
Address:
City:
Province:
Postal Code: -
Phone: --
Extension:
Fax: --
Email:
Language:
Confidentiality:
My address can be used by similar associations in order to announce meetings and educational matrial or to allow other professionals in the fields to contact me.

Payment:


60$ for an individual
20$ for a full time student
Workplace:
CLSC
Private Office
School
Public Health
City Health Department
Hospital
University
Community Organization
Youth Centres
Children Aid Society (Youth Protection)
Custodial Facilities
Government, Ministries, Governmental Organizations
School Board
Others

Profession:
Type of Work:
Clinical Intervention
Teaching
Prevention, Promotional Activities
Health Education
Clinical Coordination
Group Animation
Community Work
Public Health
Research
Administration
Documentation, Library
Volunteers
Media
Street Work
Program Development
Others

Topic of Interest:
Parent-Adolescent Relationships
Behavior Problems
Sexuality, Pregnancy
Handicaps, Chronic Diseases
Sexual Abuse
Anorexia Nervosa and Bulimia
Suicide, Suicide Attempts
STD, AIDS
Drug Abuse
General Health: Growth, Dermato, Ortho, Sports
Rights and Laws
Adolescent
Learning Disorders
Violence
Nutrition and Obesity
Psychosomatic Complaints

 
 



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