CRSN Event Registration Cancellation form

Use this form to withdraw a person from a previous registration. The deadline for changes for any course session is no later than
     One (1) week prior to the first date the course begins.
This form must be filled out once for each registration being cancelled. You will be informed if your cancellation has been processed.

To Cancel a registration, please complete all required (**) information in full.
At least one appropriate email MUST be provided.

Name of person requesting Cancellation**

Please supply the registrant's full name

Email Address of Requester

Please supply your email address

If you are submitting this request on behalf of a registrant, please fill in your name and e-mail address above.


Name on Registration to be cancelled**

Please supply the registrant's full name

Full name of registrant, spelled out completely please. Note that only one name per request will be considered.

Email Address**

Please supply your email address

Enter primary email address of the person who's registration is being canceled

Reenter Email Address**

Please supply your email address

Enter primary email address of registrant again

Organization of Registrant

Please list the name of your organization

Name of organization, business, or hospital that registrant works for

Choose course for cancellation request**
Please pick one of the courses listed; if the course is not listed, change requests will not be accepted at this time

Other course

Please give a reason why this change request is being submitted

Use field above to List any other course you wish to send a cancellation for

Please choose date of course**
Please pick the start date of the event you are making request for

Reason for Cancellation**

Please give a reason why this change request is being submitted

Use field above to explain the reason for cancellation.


IMPORTANT: At this time is is NOT possible to process fee refunds. If the cancellation being requested is for a course that requires a fee, a refund will not be available.
Acknowledgement of Terms**

Please Check if you acknowledge the terms of this agreement.


Please enter the characters you see listed here**
Please enter the characters you see listed here
Refresh Invalid Input

Click to submit request for cancellation


Contact us

Champlain Regional Stroke Network The Ottawa Hospital - Civic Campus Civic Parkdale Clinic, Main North 1053 Carling Avenue Ottawa, ON K1Y 4E9

Phone: 613-798-5555 x 16153
SPC Phone: 613-798-5555 x 16156