Medication Safety Alert! Nurse Advise-ERR

	Individual practitioner $15.00
	Single site hospital or healthcare facility $50.00
	Multiple sites (up to 3 sites) $95.00
	Multiple sites (4 to 6 sites) $130.00
	Commercial corporations $95.00
	Retail pharmacy (per store) $30.00
	Ontario hospital or Long-Term Care facility funded by the Ministry of Health and Long-Term Care (Free thanks to support from the Ministry) $0.00
	Regional or provincial subscriptions - contact ISMP Canada for more information

Online: All major credit cards are accepted by PayPal. Fill in the form below and click the Buy Now button to go to the PayPal website to complete the transaction. Ms Mrs Mr Dr First Name:   Last Name: Miss    Title:   Email: Organization: Street: City: Province/State: AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuébecSaskatchewanYukon Postal/Zip Code: Total: $15.00 (plus applicable taxes) For the total including tax, please select your country and province/state above.
Fax: Complete this pdf form and fax to 416-733-1146 with credit card information.
Mail: Complete this pdf form and mail together with cheque or credit card information to:        ISMP Canada        4711 Yonge Street, Suite 501        Toronto, Ontario, M2N 6K8
For additional information, call 1-866-544-7672 ext. 236 (416-733-3131 ext. 236) or email to info@ismp-canada.org