Sign the declaration - Physicians

Physicians' Declaration

This form is intended only for doctors who wish to sign the declaration.

If you are a concerned citizen, you can support it here.

I have read the Declaration and I support the Physicians’ Alliance against Euthanasia *

Yes No

I consent to my name appearing publicly on the list of signatures *

Yes No

Prefix *

First Name *

Last Name *

City *

Postal code *

Country *

Province/ State *

Telephone Number

Email *

Preferred language *

License Number *

Field of practice *

Newsletter *

Yes No

Urgent calls to action *

Yes No

No bulk email

Cancel