Registration

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Continuing Health Education Symposium
Managing IBD During Pregnancy:
Evidence-based strategies and guidelines to use in clinical practice
Saturday, March 12, 2016 - 09:00 to 14:15
Royal Mayfair Golf Club, 9450 Groat Road NW, Edmonton, AB
REGISTRATION/RSVP FORM
YES, I will attend as indicated below
Regrets, I cannot attend
Participant Information (please print or type)
Full name:
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Hospital affiliation and title:
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Preferred method of communication:
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Fax & phone
Other (specify):
Allergies, special dietary requests:
REGISTRATION FEES
Registration fee per delegate, per day, includes breakfast, refreshments, lunch and meeting materials
EARLY BIRD Discount
ON or BEFORE February 12, 2016
REGISTRATION
AFTER February 12, 2016
Physicians and Surgeons
$75.00
$90.00
Allied Healthcare Professionals
Postgraduate Residents & Fellows
$35.00
$50.00
PAYMENT
Cheque payable to: Catrile & Associates Ltd., 1B–391 Berkeley Street, Toronto, Ontario M5A 2X8
Credit card:
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Card number:
CSC code (3 digits on back of card):
Cardholder name (name as is it appears on credit card):
Cancellation/Refund Policy: A $35.00 administrative fee will apply to cancellations received in writing on or before March 1,
2016. No refund policy is applicable to cancellations received after March 1, 2016.
To register for Managing IBD During Pregnancy complete this form and
♦ Fax: Catrile & Associates Ltd. 416-519-0243
♦ Email: lois.logie@rogers.com
♦ Telephone: Catherine Riley 647-261-3997 or Lois Logie 647-203-6116.
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