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INSTRUCTIONS: Please ensure you read the program requirements as outlined in the IIPC program guide prior to completing this registration form. Please only submit one application per location. If you have any questions while filling out the application, please email: independentimmunizationpartners@gov.mb.ca.
Note: this is the 5-digit number your location uses to order publicly funded vaccines through the Provincial Distribution Warehouse).
Please refer to the Independent Immunization Partners Channel Program Guideline for requirements.
Upon receipt of your application, a member of the IIPC team will follow up to discuss the status of your application and next steps.