Registration

Registration Form

This form allows you to become a member of AMOM (certain conditions apply) or to create an online account.

Details on the type of registration:

Member Registration :

Select this type of registration if you are an existing member of the AMOM and want to create your online account.
Select this type of registration if you wish to become a member of the AMOM. You will automatically have an online account.

A physician choosing to become a member of AMOM does so freely and voluntarily. They commit to adhering to the Statutes and Regulations of the Montreal Association of General Practitionersl. Additionally, the physician consents to being included in the distribution list for electronic communications intended for members (FLASH-AMOM). They retain the right to unsubscribe at any time after receiving a FLASH-AMOM. The Association will act on their behalf when the interests of general practitioners or the profession require.

Other Health Professional Registration :

Select this type of registration if you are another health professional (resident, specialist physician, nurse, pharmacist, physiotherapist, etc.) and want to create an online account to register for medical training. (Modifications may be made without notice).

Non-member Physician Registration :

Select this registration type if you are a non-member physician of the AMOM and wish to create an online account to enroll in Continuing Medical Education (CME) activities (fees will be charged for activities starting from June 1st).

Non-Member Retired Physician Registration :

Select this registration type if you are a retired physician and not a member of the AMOM, and wish to create an online account to enroll in Continuing Medical Education (CME) activities (fees will be charged for activities starting from June 1st).

Membership type

Identifier (for connection)(Required)

All personal information below will be for the exclusive use of the Association, and it will only be used in case of necessity.

First name(Required)

Last name(Required)

License number (CMQ)(Required)

Profession(Required)

Name of practice location(Required)

Practice address(Required)

Street Address City Postal Code

I agree to display my professional contact information on the members' directory (visible only to other members).

Practice phone(Required)

Home address(Required)

Street Address City Postal Code

Home phone(Required)

Cellphone(Required)

Email(Required)

Date of birth(Required)

By subscribing, I agree to be added to the mailing list for electronic communications to members (FLASH-AMOM). I can, if I wish, unsubscribe at any time after sending a FLASH-AMOM. By subscribing, I agree to be added to the mailing list for electronic communications to members (FLASH-AMOM). I can, if I wish, unsubscribe at any time after sending a FLASH-AMOM. The Association will act on my behalf when the interests of general practitioners or those of the profession so require.

In witness whereof I have signed the(Required)

Hidden

Electronic signature(Required)

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