2025 New Lab Registration (all prices in CAD) Spam protection, skip this field Complete this form if you are not already a participant in CPQA-AQCP surveys and have no assigned Lab ID. All prices are in CAD. PLEASE NOTE that the $300 annual registration and administration fee will now be due immediately once your 2025 subscription form has been submitted. Laboratory Name Email Of the representative submitting this subscription Laboratory Phone Number Mailing Address Physical slides will mailed to this address. Billing Address (if different than mailing address) (optional) Please provide billing contact name and email if possible. Technologist Name Technologist Email Address Pathologist Name Pathologist Email Address 2025 IHC Subscriptions Available: (optional) H&E (2 x $100; assessment of fixation, mounting, sectioning and staining of YOUR OWN H&Es) Prostate p63 ($150 per unstained slide; see following question) Prostate AMACR ($150 per unstained slide; see following question) Prostate basal epithelial keratin ($150 per unstained slide; see following question) Gastric HER2 IHC (2 x $250) HMB45 ($250) PD-L1 (2 x $200; technical assessment only) MMR ($600) HSV ($250) ER ($250) PR ($250) HER2 Breast IHC ($300; emphasis on HER2-low) c-Myc lymphomas ($250) pan-TRK IHC ($300) BRAFV600E CRC ($250) ROS1 ($200; technical assessment) p53 endometrial ($300) Chromogranin A ($200) p16 ($250) CK20 ($200) CD117 ($250) CD20 ($250) Synaptophysin ($200) ALK in NSCLC ($250) Ki67 in breast ($250) BRAFV600E melanoma ($250) Calretinin ($200) IDH1 R132H ($250) ATRX ($250) p53 vulvar ($250) PRAME ($250) If p63/AMACR/prostate basal epithelial keratin were selected above, how many unstained slides do you require? (optional) Choose 1 unstained slide (e.g. triple stain) 2 unstained slides (e.g. one double stain + one single stain) 3 unstained slides Pricing of $150 applies to each unstained slides required. 2025 ISH Subscriptions Available: (optional) Gastric HER2 ISH ($25) ALK ISH ($25) Breast HER2 ISH ($25) 1p19q FISH ($25) 2025 Molecular EQA Subscriptions (optional) NSCLC (No fee) Can you provide a PO Number? Choose Yes, I can provide it now. No, I need an estimate from the CPQA before generating a PO. PO Number Other comments (optional) If you run multiple clones for a biomarker (e.g. PD-L1 or HSV) or separate assays (e.g. CEP17 and HER2 ISH), indicate so here and multiple slides can be sent if requested. Please note that optimization assistance for any above subscriptions is included (i.e. our samples can be used for EQA and validation). The $300 annual registration and administration fee is due upon submission of this online form. How did you wish to pay for it? Choose Credit card Send me an invoice once this order is processed For taxation purposes, is your institution located in Canada? Choose Yes No For taxation purposes, is your institution located in British Columbia? Choose Yes No