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To register with MSProgram.ca, please fill out your personal information below:
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Username:
(Your email address will be your username)
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Password:
(7-16 characters)
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Re-enter Password:
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Language Preference:
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First Name:
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Last Name:
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Nickname:
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Phone:
Address:
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City:
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Province:
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Postal Code:
Occupation:
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Gender:
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By checking this box, I am confirming that I am taking Rebif
®
By checking this box, I am confirming that I am a member of the Multiple Support Program
If you’re not a member of the Multiple Support Program, or are unsure, please contact us by phone at 1-888-677-3243 or
email
to learn more about the program and to enrol.
* Mandatory Fields