Step 1: Registration CAPA - ACAM > Step 1: Registration Membership TypeType d'adhésion* Regular / RégulierStudent / ÉtudiantRetired PA (Regular) / AM retraité (Régulier)International PA / AM InternationalInternational PA Student / Étudiant AM InternationalAllied Health Profession / Profession affiliée au secteur des soins de santéPhysician / MédecinRetired Physician / Médecin retraitéNew Graduate / Nouveau diplôméNon-PA CPD Tracking Tool / Non-AM pour l'utilisation de l'outil de suivi de la FPC About youau propos de vousFirst NamePrénom* Last NameNom* Email* PasswordMot de passe Retype PasswordMot de passe GenderSexe* Male Female Birth YearAnnée de naissance* Contact informationCoordonnéesHome PhoneNuméro de téléphone maison* Office PhoneNuméro de téléphone bureau Secondary EmailEmail secondaire Mailing addressAddresseStreet AddressAddresse* CityVille* CountryPays* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and 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MedicineFamily MedicineGeneral SurgeryGeriatricsInternal MedicineMedical OncologyNephrologyNeurologyNeurosurgeryObstetrics and GynecologyOrthopaedicsOrthopaedic SurgeryOncology/Bone Marrow TransplantPediatricsPlastic SurgeryPrimary CarePsychiatryRheumatologyRehabilitation SurgeryRehabilitation MedicineSports MedicineSurgical OncologyThoracic SurgeryUrologyVascular SurgeryOtherNot Applicable/Sans Objet Area of Specialty (other)Domaines de spécialité (autre) PACCC Certified?PACCC certifié?* Yes No PACCC Certification YearPACCC certification Année NCCPA Certified?NCCPA certifié?* Yes No NCCPA Certification YearNCCPA certification Année Proof of Graduation / Preuve d'obtention du diplôme Proof of student status<br>Preuve de statut d'étudiant ChapterChapitre* Pacific Prairie Ontario Québec Atlantic Student International Students must select their local chapter as well as the Student chapterLes étudiants doivent choisir leur section locale ainsi que le chapitre étudiant ConsentConsentementI 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