REGISTRATION FORM Conference on “Ensuring a Healthy Start for the Pediatric Population” Friday 7th December 2012- Maamari Auditorium, Olayan School of Business – AUB Registration Registration Fees: 50,000 LBP per individual* * Registration fees should be paid on site. Registration fees cover a CD that includes all the PowerPoint presentations, lunch and one coffee break For those interested in obtaining a certificate of attendance, registration should be done through Email by sending the registration form to Dr. Dina Zebian at dz12@aub.edu.lb (Deadline : December 2nd, 2012) Please complete the contact information below. Personal Details Title Gender Contact Details Mailing Address E-mail Address Daytime Telephone Employment Details Position Institution First Name Family Name Male Female