Registration Form for TPP - Medical Residents

  • NOTE: If you are already registered with TPP Alberta, you do not have to complete this form to re-order pads.
  • Registrant information

  • Information printed on pad

  • Shipping information

  • (NOTE: NO PO BOXES or OUT OF PROVINCE addresses allowed)
    A signature is required at time of delivery.
  • Program Coordinator/Supervisor

    TPP Alberta will contact your supervisor for verification before your registration is processed.
  • Signature

  • *Please use CPSA verified email
  • MM slash DD slash YYYY
  • We collect and share the personal information in this form for the purposes of registering you in TPP Alberta. We may share your information with the printing and courier vendors for the purpose of producing the secure pads, OR with regulatory organizations as set out in CPSA Bylaws for TPP Alberta. If you have any questions about collecting your information, please contact TPP Alberta at, 780-969-4939 or toll-free at 1-800-561-3899.
  • This field is for validation purposes and should be left unchanged.