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: Degrees/Designations: Academic affiliation and title: Hospital affiliation and title: Mailing address: City: Province: Phone: Fax: Preferred method of communication: E-mail Postal Code: E-mail: 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, Surgeons, PhDs & Pharmacists $75.00 $90.00 Postgraduate Residents, Fellows & RNs $35.00 $50.00 PAYMENT Cheque payable to: Catrile & Associates Ltd., 1B–391 Berkeley Street, Toronto, Ontario M5A 2X8 Credit card: Expiry date: VISA MasterCard 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.