Registration form for volunteers

Personal Information

Membership No. CORNQ or Registration Code

* :

Enter a valid member number / registration code

Mrs.
Mr.

Name * :

First Name * :

Address * :

City * :

Province * : --- Select a province -- Alberta British Columbia Prince Edward Island Manitoba New Brunswick Nova Scotia Nunavut Ontario Quebec Newfoundland and Labrador Saskatchewan Northwest Territories Yukon

Postal Code * :

Phone Number * :

Personal Email* :

Professional Information

I don't have professional informations

Name of Integrated Health and Social Services Centre or Employer * :

Address * :

City * :

Province * : --- Select a province -- Alberta British Columbia Prince Edward Island Manitoba New Brunswick Nova Scotia Nunavut Ontario Quebec Newfoundland and Labrador Saskatchewan Northwest Territories Yukon

Postal Code * :

Work Phone :

Extension :

Job Title / Function * : Select your job title ORNAC BOARD CORL RN RN CPN(C) TEAM LEADER RNFA EDUCATOR AHN MANAGER Other

Specify if Other  :

Professional Email  :

Package description : *

Cost per conference day Can$ 270

Cost for the 2 days of conference: Can$ 495

Cost for the 3 days of conference: FREE

Dates	Conference and Exhibitor Hours
Friday, April 17, 2026	7:45 a.m. to 5:15 p.m.
Saturday, April 18, 2026	7:30 a.m. to 3:40 p.m.

Check the days you would like to register for * :

Friday, April 17, 2026

- free

Saturday, April 18, 2026

- free

Do you have any allergies or dietary restrictions? *

No Yes

If yes, specify the type of allergy or restriction  

Credit Card Information

Firstname* :

Name* :

Postal Code* :

Card number* :

Expiration date*  : - Month - 1 2 3 4 5 6 7 8 9 10 11 12 - year - 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 2045 2046

CVV* :

I accept the terms of payment stated on this site.

Subtotal :

Can$ 0

GST :

Can$ 0

QST :

Can$ 0

TOTAL PAYMENT :

Can$ 0

CONFIRM YOUR INFORMATION BEFORE SUBMITTING

Personal Information
CORNQ's Membership Number :	Empty
Gender :	Empty
Name :	Empty
First Name :	Empty
Address :	Empty
City :	Empty
Province :	Empty
Postal Code :	Empty
Phone Number :	Empty
Personal Email :	Empty
Professional Information
Name of Integrated Health and Social Services Centre or Employer :	Empty
Address :	Empty
City :	Empty
Province :	Empty
Postal Code :	Empty
Work Phone :	Empty
Extension :	Empty
Job Title / Function :	Empty
Specify if Other :	Empty
Professional Email :	Empty
Credit Card Information Firstname : Name : Postal Code / Doctorate : Card number : Expiration date : CVV :
2026 CORNQ provincial conference registration
Number of days :	Empty
Days Attended :	Empty
Allergies or dietary restrictions
Empty	Empty
TOTAL PAYMENT :	Empty

Are all information correct ?

   

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Currency : All payments are in Canadian dollars only.

Cards accepted : You can complete transactions using Visa or MasterCard.

Privacy Policy : The CORNQ site is secured with SSL standard and, through their highly secure connections, Desjardins and Optimal, ensure the confidentiality of information that you submit during the transaction. All personal information collected will be used only for the payment of sites and enrollment management and will, under no circumstances be sold to any third party.