2015 Medical Psychiatry Alliance Conference: October 30, 2015

Registration Form





























  • Registration Category

  • Workshop Preferences

    Please rank your workshop preferences below (scale 1-3).
    Note: The MPA will aim to place all registrants in the breakout sessions of their first choice. However, the final decision regarding the placement of participants in the breakout sessions will be based on session capacity.
  • Session 1 – 10:30 AM

    Identifying and creating core competencies in MPA

  • Session 2 – 2:30 PM

    Development of integrated and collaborative medical psychiatry curricula for MPA

  • Participant Bio and Photograph

    The MPA will be including brief bios and photos of all participants in the Friday, October 30 session in the conference booklet. Please provide a brief bio (max. 150 words) and upload a high resolution photo for inclusion in the conference booklet. Deadline for uploading your bio and photo is Friday, September 25, 2015.
  • All participants are asked to provide a brief bio for inclusion in the conference booklet (max 150 words). Please upload your bio by Friday, September 25, 2015.
  • Accepted file types: jpg, gif, png.

    All participants are asked to upload a high resolution photograph for inclusion in the conference booklet. Please upload your photo by Friday, September 25, 2015.
    (Max. file size 50 MB)
  • Other Information

    Kindly indicate if you have any dietary restrictions.


    Photographs, videos and audio recordings of the 2nd Annual Medical Psychiatry Conference may be produced and may include your recognizable image. By participating in this event, you therefore consent to being photographed, video-taped and audio-taped and you authorize The Medical Psychiatry Alliance to use any of these recordings for its activities and events, as well as for its print and electronic promotional material, including via the website or other social media websites.