Create New User Account

* Denotes a mandatory field
Name
Prefix
First Name*
Middle Name
Last Name*
Contact Information
Street Address*
City/Town*
Country*
Province*
State*
Postal Code/Zip Code*
Preferred Telephone Number*

(###) ###-####
Professional Information
What is your main profession?*
What is your primary specialty or area of expertise?*
What is your primary specialty as a physician?*
What Type of Professional Are You?*
What is your Speciality?*
Are you a member of the Association of General Dentistry (AGD)
- Yes
- No
What is your AGD Number?*
Do you have a faculty appointment OR are you a student at the University of Manitoba?*
- Yes
- No
What is your primary College affiliation in the Faculty of Health Sciences?
Are you primarily a:
Year of first U of M academic appointment
What is your teaching setting?
In which educational programs have you primarily taught over the last 5 years?
Please list the multiple programs in which you teach
Additional Information
What is the primary geographical setting of your work?
What is the primary practice settings in which you work?
In what year were you first licensed for practice?
Account Information
Primary Email*
This email address will be used to login.
Enter Primary Email Confirm Primary Email
Secondary Email
Add an secondary email address to have a copy of your registration details emailed to: an assistant, an alternate workplace, etc. Please note this address cannot be used to login to your profile.
Enter Secondary Email Confirm Secondary Email
Password*
Enter Password Confirm Password

Strength indicator

Please note that your Password must be rated as "Good" or "Strong" to proceed.
CAPTCHA
After your registration is submitted, choose My Event Cart at the top right to complete any event ticket purchase in progress.

Create New User Account

Name

Contact Information

Professional Information

Additional Information

Account Information

Our Mission

Office of Continuing Competency and Assessment

Connect With Us!

Accessibility

Notice Regarding Collection, Use, and Disclosure of Personal Information by the University:

This website uses cookies so that we can remember you and understand how you and other visitors use this website, and in order to improve the user experience.