Pall Ed Network Registration Process Step 1 of 4 25% This field is hidden when viewing the formSuperuserInvitation No Yes Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Suffix Email(Required)We encourage you to input your organization email to facilitate enhanced access to some limited areas Organizational Affiliation(Required)Is your work location within BC?(Required) Yes No Address(Required) State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Profession(Required)Please choose your professionEmergency Medical Service ProviderHealth Care AssistantHealth Care StudentLicensed/Registered Practical Nurse (LPN/RPN)Medical ResidentNurse Pracitioner (NP)Occupational TherapistPharmacistPhysicianPhysiotherapistRegistered DietitianRegistered Nurse (RN)Respiratory TherapistSocial Worker/CounsellorSpiritual Care ProviderOtherDescription of Other(Required)Does your work involve developing palliative education materials?(Required) Yes No Please check the checkbox below if you work in a small rural, remote, or isolated area. Yes This field is hidden when viewing the formWhat type of community?Please chooseSmall Rural (1000 – 3500 people)Remote (<1000 people)Remote and isolated (>50 km from nearest service centre and no year-round access)What type of community?Choose all that apply. Small Rural (1000 – 3500 people) Remote (<1000 people) Remote and isolated (>50 km from nearest service centre and no year-round access) Select AllDoes more than 20% of your practice include working with indigenous people? Yes No As a member of the Pall Ed BC Network, you will receive periodic communications about the Network's features and developments.In addition, please specify your preferences for the following engagements: 1. Yes, please invite me to be reviewer/test user 2. Yes, please invite me to join a working group Letter of Agreement to Access Pall Ed BC Repository As a developer of palliative education employed in an approved institution, you are invited to join the Pall Ed BC Repository. Pall Ed BC Repository is a secure, curated environment for developers of palliative care education to collaborate and share resources. Please read and complete the Letter of Agreement below to gain access to the Repository. By signing it, you acknowledge that you are a palliative education developer and agree to: use resources in the repository according to the permitted use given by the author/uploader if the resource is used in a program where participants are required to pay a fee, written permission from the author/uploader is required this includes not using the resources in for-profit activities appropriately credit the author and organization of the resources you access keep your access confidential and not share it with anyone else By selecting a choice below, you indicate that you have read, understood, and agree to all the above(Required) I agree Thank you for the offer but I do not wish to access the Repository Click next to complete your registration to Pall Ed BC Network.Click next to complete your registration to Pall Ed BC Network and Repository. Letter of Agreement to Access Pall Ed BC Repository You are invited to join the Pall Ed BC Repository. Pall Ed BC Repository is a secure, curated environment for developers of palliative care education to collaborate with others, post completed documents, and share about resources in process. Please read and complete the Letter of Agreement below to gain access to the Repository. By signing it, you acknowledge that you are a palliative education developer and agree to: use resources in the repository according to the permitted use given by the author/uploader if the resource is used in a program where participants are required to pay a fee, written permission from the author/uploader is required this includes not using the resources in for-profit activities appropriately credit the author and organization of the resources you access only post resources that meet the Repository’s criteria: target learners are healthcare clinicians addresses palliative competencies posted with permission of your organization or is your own intellectual property endorsed by or developed on behalf of organization/program, or peer-reviewed provide your email and be contacted about resources you post keep your access confidential and not share it with anyone else By clicking the circle below, you indicate that you have read, understood, and agree to all the above(Required) I agree Click next to complete your registration to Pall Ed BC Network and Repository. This field is hidden when viewing the formDo you already have an account on this website?(Required)If you already can log in to this web site with the email address you have provided (for example to access the Serious Illness Conversations community of practice), you will use that same username and password to access your resources. If you do not have an account, we will create one for you. Yes No Not sure Not sure? Visit this link which will open in a new tab, click the ‘forgot password’ link and enter in your email address. The system will either send you a password reset email or tell you your email address isn’t on the system. Then return here and change your response to yes or no above.CAPTCHA Pall Ed Network Registration Process Step 1 of 4 25% This field is hidden when viewing the formSuperuserInvitation No Yes Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Suffix Email(Required)We encourage you to input your organization email to facilitate enhanced access to some limited areas Organizational Affiliation(Required)Is your work location within BC?(Required) Yes No Address(Required) State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Profession(Required)Please choose your professionEmergency Medical Service ProviderHealth Care AssistantHealth Care StudentLicensed/Registered Practical Nurse (LPN/RPN)Medical ResidentNurse Pracitioner (NP)Occupational TherapistPharmacistPhysicianPhysiotherapistRegistered DietitianRegistered Nurse (RN)Respiratory TherapistSocial Worker/CounsellorSpiritual Care ProviderOtherDescription of Other(Required)Does your work involve developing palliative education materials?(Required) Yes No Please check the checkbox below if you work in a small rural, remote, or isolated area. Yes This field is hidden when viewing the formWhat type of community?Please chooseSmall Rural (1000 - 3500 people)Remote (<1000 people)Remote and isolated (>50 km from nearest service centre and no year-round access)What type of community?Choose all that apply. Small Rural (1000 - 3500 people) Remote (<1000 people) Remote and isolated (>50 km from nearest service centre and no year-round access) Select AllDoes more than 20% of your practice include working with indigenous people? Yes No As a member of the Pall Ed BC Network, you will receive periodic communications about the Network's features and developments.In addition, please specify your preferences for the following engagements: 1. Yes, please invite me to be reviewer/test user 2. Yes, please invite me to join a working group Letter of Agreement to Access Pall Ed BC Repository As a developer of palliative education employed in an approved institution, you are invited to join the Pall Ed BC Repository. Pall Ed BC Repository is a secure, curated environment for developers of palliative care education to collaborate and share resources. Please read and complete the Letter of Agreement below to gain access to the Repository. By signing it, you acknowledge that you are a palliative education developer and agree to: use resources in the repository according to the permitted use given by the author/uploader if the resource is used in a program where participants are required to pay a fee, written permission from the author/uploader is required this includes not using the resources in for-profit activities appropriately credit the author and organization of the resources you access keep your access confidential and not share it with anyone else By selecting a choice below, you indicate that you have read, understood, and agree to all the above(Required) I agree Thank you for the offer but I do not wish to access the Repository Click next to complete your registration to Pall Ed BC Network.Click next to complete your registration to Pall Ed BC Network and Repository. Letter of Agreement to Access Pall Ed BC Repository You are invited to join the Pall Ed BC Repository. Pall Ed BC Repository is a secure, curated environment for developers of palliative care education to collaborate with others, post completed documents, and share about resources in process. Please read and complete the Letter of Agreement below to gain access to the Repository. By signing it, you acknowledge that you are a palliative education developer and agree to: use resources in the repository according to the permitted use given by the author/uploader if the resource is used in a program where participants are required to pay a fee, written permission from the author/uploader is required this includes not using the resources in for-profit activities appropriately credit the author and organization of the resources you access only post resources that meet the Repository's criteria: target learners are healthcare clinicians addresses palliative competencies posted with permission of your organization or is your own intellectual property endorsed by or developed on behalf of organization/program, or peer-reviewed provide your email and be contacted about resources you post keep your access confidential and not share it with anyone else By clicking the circle below, you indicate that you have read, understood, and agree to all the above(Required) I agree Click next to complete your registration to Pall Ed BC Network and Repository. This field is hidden when viewing the formDo you already have an account on this website?(Required)If you already can log in to this web site with the email address you have provided (for example to access the Serious Illness Conversations community of practice), you will use that same username and password to access your resources. If you do not have an account, we will create one for you. Yes No Not sure Not sure? Visit this link which will open in a new tab, click the 'forgot password' link and enter in your email address. The system will either send you a password reset email or tell you your email address isn't on the system. Then return here and change your response to yes or no above.CAPTCHA
