Registration form

Fields marked with an asterisk (*) are mandatory

*First name:

*Last name:

*Affiliation:

*Address:

Address line 2:

*City:

*State/Province:

*Zip/Postal Code:

*Country:

*Phone:

Fax:

*Email:

Banquet-Dinner on the Louis-Jolliet Cruise Ship on Sunday September 28, 2008 (50$ CAD / ticket):Number of tickets: X $50.00 CAD per ticket = $0.00

Lunch Box: Monday September 29 (13.00$)
Tuesday September 30 (13.00$)

Please indicate any special needs:

*Please indicate if you will require a Certificate of Attendance: Yes
No

*Please indicate if you will request Continuing Medical Education (CME) or Continuing Professional Development (CDP) credits. An additional charge of $50 CAD will be added to registration fees for all participants who wish to claim CME or CDP credits. No
CME credits
CDP credits

*Please select a category: Regular ($450 up to August 11th; $525 after August 11th)
Regular / day($180). Number of days:
Trainee ($160 up to August 11th; $195 after August 11th)
Trainee / day($70). Number of days:
Accompanying person ($40)

* Reduced rate ends August 11th at midnight, Eastern Standard Time
Price for inscription = $0

*Participant type: Academic Scientist
Faculty Member
Commercial Scientist and/or Administrator
Undergraduate Student
Graduate/Medical Student
Fellow
Doctoral Student
Post Doctoral Student

*Payment method: Check
Credit card (VISA, MasterCard, American Express)

Total price = $0