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First Name *

Last Name *

Username *

Display Name

User Password *Your password must be at least 'medium' strength for the form to submit.

Confirm Password *

User Email *

City / Town of your workplace *

Province *

AHS Zone *Please look up AHS zone map if you need help. https://www.albertahealthservices.ca/ahs-map-ahs-zones.pdf

My School Authority / Workplace is Considered *

What Grades do you Primarily Teach? *

If you are not a Teacher, What is Your Main Role? *

School Authority Type *This is an Alphabetized List from the Alberta Education website, as of July 2019

School Authority (e.g. Calgary Board of Education) *Please type in which school authority you work for. If you do not work in the school system, please enter N/A.

Other Organization

Your workplace postal code