Trillium Primary Care Research Forum 2006


June 2, 2006, 8:30am to 3:30pm

Conference Fees and On-line Registration Information

Fees include free-standing paper sessions, a lunch with Key Note Speaker, Rick Glazier as well as refreshments and light snacks during the morning registration and poster sessions.

To register fill in the information below and finish by clicking the "Submit" button.

Please make cheque payable to "McMaster University ", and forward via mail attention Debra Lockey, within one week of registering.


TRILLIUM 2006 ON-LINE REGISTRATION

Title:
First Name:
Last Name:
Institutional Affiliation/Company:
Street Address:
City/Town:
Province:
Postal Code:
Telephone:
Fax:
E-mail:

STATUS

Physician
Allied Health Professional
Resident/Student

Select the appropriate fees from the list option below:

Fee Payment can be made by cheque:

Please make cheques payable to McMaster University, Department of Family Medicine

Forward your registration with cheque to:


FOR FURTHER INFORMATION CONTACT:
Debra Lockey E-mail

Department of Family Medicine,
McMaster University,
75 Frid Street, Hamilton ON L8P 4M3
T: 905-521-2100 ext 28509   &   F: 905-527-4440



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