CERTIFICATE REQUEST FORM
Continuing Health Professional Education, McGill University
Please complete this Certificate Request form. To be submitted two (2) weeks before the event.
The information provided below will be displayed on the certificate.
Activity title: exactly as it will appear on the certificate
Course Director: Please check: Certificate should be in:
Shipping address: Organization name, civil address, room number, city, postal code, etc...
Date(s) on Certificate(s) Maximum Number Credits Quantity of Certificates
The certificates are $2.50**/ea and personalized attestation letters are $20.00 each.
A $ 50 express fee is applicable if certificate request form is submitted less than 2 weeks prior to event.
A shipping/handling fee will be charged if delivery is outside of the MUHC.
**McGill/MUHC activities: reduced rate will apply
Contact person for enquiries:
CHPE Office Use:
Continuing Health Professional Education
Lady Meredith House, McGill University □ Approval pending
1110 Pine Avenue, Room 301
Montreal, Quebec H3A 1A3
Date of receipt: