{"id":33,"date":"2026-05-20T20:46:13","date_gmt":"2026-05-21T00:46:13","guid":{"rendered":"http:\/\/pharmascience.local\/registration\/"},"modified":"2026-09-03T05:26:17","modified_gmt":"2026-09-03T09:26:17","slug":"registration","status":"publish","type":"page","link":"https:\/\/lms.clearoute.dev\/en\/registration\/","title":{"rendered":"Register"},"content":{"rendered":"<p class=\"bnrmp-auth__lede\">Healthcare practitioners can register below for the <sup>N<\/sup>pms-BUPRENORPHINE-NALOXONE Education Program.<\/p>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital bnrmp-registration_wrapper' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_1' style='display:none'><style>#gform_wrapper_1[data-form-index=\"0\"].gform-theme{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 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var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1' class='bnrmp-registration' action='\/en\/wp-json\/wp\/v2\/pages\/33#gf_1' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_15\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_15'><span class='gform-field-label__text'>Comments<\/span><\/label><div class='ginput_container'><input name='input_15' id='input_1_15' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_15'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_1_1\" class=\"gfield gfield--type-text gf_left_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_1'><span class='gform-field-label__text'>First Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='100' data-text-counter-template='{current} of {max} max characters'><input name='input_1' id='input_1_1' type='text' value='' class='' maxlength='100'    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"given-name\" \/><\/div><\/div><div id=\"field_1_2\" class=\"gfield gfield--type-text gf_right_half gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_2'><span class='gform-field-label__text'>Last Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='100' data-text-counter-template='{current} of {max} max characters'><input name='input_2' id='input_1_2' type='text' value='' class='' maxlength='100'    aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"family-name\" \/><\/div><\/div><div id=\"field_1_3\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_3'><span class='gform-field-label__text'>Profession \/ Title<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_1_3' class='gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select a profession<\/option><option value='Physician' >Physician<\/option><option value='Nurse Practitioner' >Nurse Practitioner<\/option><option value='Pharmacist' >Pharmacist<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'><span class='gform-field-label__text'>Specialty<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_1_12' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select a specialty<\/option><option value='Anesthesiology' >Anesthesiology<\/option><option value='Bacteriology\/Microbiology\/Infectious Diseases' >Bacteriology\/Microbiology\/Infectious Diseases<\/option><option value='Cardiology' >Cardiology<\/option><option value='Diagnostic Radiology' >Diagnostic Radiology<\/option><option value='Emergency Medicine' >Emergency Medicine<\/option><option value='Family Medicine' >Family Medicine<\/option><option value='Gastroenterology' >Gastroenterology<\/option><option value='General Practitioner' >General Practitioner<\/option><option value='Geriatrics' >Geriatrics<\/option><option value='Hematology' >Hematology<\/option><option value='Internal Medicine' >Internal Medicine<\/option><option value='Nephrology' >Nephrology<\/option><option value='Neurology' >Neurology<\/option><option value='Obstetrics &amp; Gynaecology' >Obstetrics &amp; Gynaecology<\/option><option value='Oncology' >Oncology<\/option><option value='Otolaryngology (ENT)' >Otolaryngology (ENT)<\/option><option value='Pediatrics' >Pediatrics<\/option><option value='Psychiatry' >Psychiatry<\/option><option value='Respirology' >Respirology<\/option><option value='Rheumatology' >Rheumatology<\/option><option value='Surgery' >Surgery<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_1_13\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_13'><span class='gform-field-label__text'>Specialty<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_1_13' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select a specialty<\/option><option value='Medical Interns\/Residents' >Medical Interns\/Residents<\/option><option value='Medical student' >Medical student<\/option><option value='Other Miscellaneous' >Other Miscellaneous<\/option><\/select><\/div><\/div><div id=\"field_1_14\" class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_14'><span class='gform-field-label__text'>Please specify<\/span><\/label><div class='ginput_container ginput_container_text' data-text-counter-max='100' data-text-counter-template='{current} of {max} max characters'><input name='input_14' id='input_1_14' type='text' value='' class='large' maxlength='100' aria-describedby=\"gfield_description_1_14\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_14'>Only if you selected \"Other Miscellaneous\".<\/div><\/div><div id=\"field_1_4\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_4'><span class='gform-field-label__text'>Medical License Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_1_4' type='text' value='' class=''     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1_5\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Email Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1_5_container'>\n                                <span id='input_1_5_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_5' id='input_1_5' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_5' class='gform-field-label gform-field-label--type-sub '>Email Address<\/label>\n                                <\/span>\n                                <span id='input_1_5_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_5_2' id='input_1_5_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1_5_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_1_6\" class=\"gfield gfield--type-password gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Password<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_password gform-grid-row' id='input_1_6_container'>\n\t\t\t\t\t\t<span id='input_1_6_1_container' class='ginput_password ginput_left gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_6' id='input_1_6' autocomplete=\"new-password\" onkeyup='gformShowPasswordStrength(this);' onchange='gformShowPasswordStrength(this);' aria-describedby=\"input_1_6_strength_indicator gfield_description_1_6\" value=''   aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t<button type='button' class='gform_show_password gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' onclick='javascript:gformToggleShowPassword(this);' aria-live='polite' aria-label='Show Password' data-label-show='Show Password' data-label-hide='Hide Password'><span class='dashicons dashicons-hidden' aria-hidden='true'><\/span><\/button>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<label for='input_1_6' class='gform-field-label gform-field-label--type-sub '>Password<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<span id='input_1_6_2_container' class='ginput_password ginput_right gform-grid-col gform-grid-col--size-auto'>\n\t\t\t\t\t\t\t<span class='password_input_container'>\n\t\t\t\t\t\t\t<input type='password' name='input_6_2' id='input_1_6_2' autocomplete=\"new-password\" onkeyup='gformShowPasswordStrength(this);' onchange='gformShowPasswordStrength(this);' value=''   aria-required=\"true\" aria-invalid=\"false\" \/>\n\t\t\t\t\t\t\t<button type='button' class='gform_show_password gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' onclick='javascript:gformToggleShowPassword(this);' aria-live='polite' aria-label='Show Password' data-label-show='Show Password' data-label-hide='Hide Password'><span class='dashicons dashicons-hidden' aria-hidden='true'><\/span><\/button>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<label for='input_1_6_2' class='gform-field-label gform-field-label--type-sub '>Confirm Password<\/label>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<div class='gf_clear gf_clear_complex'><\/div>\n\t\t\t\t\t<\/div><div id='input_1_6_strength_indicator' class='gfield_password_strength'  aria-live='assertive' aria-atomic='true'>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tStrength indicator\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input type='hidden' class='gform_hidden' id='input_1_6_strength' name='input_6_strength' \/><div class='gfield_description' id='gfield_description_1_6'>Minimum 10 characters (include at least one uppercase letter, one lowercase letter, number, and special character)<\/div><\/fieldset><div id=\"field_1_7\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_7'><span class='gform-field-label__text'>Province \/ Geography<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_1_7' class='gfield_select'    aria-required=\"true\" aria-invalid=\"false\" autocomplete=\"address-level1\"><option value='' selected='selected' class='gf_placeholder'>Select a province<\/option><option value='AB' >Alberta<\/option><option value='BC' >British Columbia<\/option><option value='MB' >Manitoba<\/option><option value='NB' >New Brunswick<\/option><option value='NL' >Newfoundland and Labrador<\/option><option value='NS' >Nova Scotia<\/option><option value='NT' >Northwest Territories<\/option><option value='NU' >Nunavut<\/option><option value='ON' >Ontario<\/option><option value='PE' >Prince Edward Island<\/option><option value='QC' >Quebec<\/option><option value='SK' >Saskatchewan<\/option><option value='YT' >Yukon<\/option><\/select><\/div><\/div><fieldset id=\"field_1_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Language Preference<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_8'>\n\t\t\t<div class='gchoice gchoice_1_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='en'  id='choice_1_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_8_0' id='label_1_8_0' class='gform-field-label gform-field-label--type-inline'>English<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='fr'  id='choice_1_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'>French<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_9\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Privacy Policy &amp; Terms<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_9'><div class='gchoice gchoice_1_9_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_9.1' type='checkbox'  value='1'  id='choice_1_9_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_9_1' id='label_1_9_1' class='gform-field-label gform-field-label--type-inline'>I have read and agree to the <a href=\"\/en\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">Privacy Policy<\/a> and <a href=\"\/en\/terms-and-conditions\/\" target=\"_blank\" rel=\"noopener\">Terms &amp; Conditions<\/a>.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_10\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Training Records<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_10'><div class='gchoice gchoice_1_10_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_10.1' type='checkbox'  value='1'  id='choice_1_10_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_10_1' id='label_1_10_1' class='gform-field-label gform-field-label--type-inline'>I understand that my training progress and completion records \u2014 including quiz results and the date my certificate is issued \u2014 will be stored by Pharmascience and its service providers, and retained as described in the <a href=\"\/en\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">Privacy Policy<\/a>.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_11\" class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Optional: Future Survey<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_11'><div class='gchoice gchoice_1_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='1'  id='choice_1_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1' class='gform-field-label gform-field-label--type-inline'>Optional: I agree to be contacted at the email address above to take part in a survey about this program, should Health Canada request one at a later date. 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