Registration Form

A. Identification


Medical Speciality:
Professional License Number

B. Special Needs

D. Registration Fees

For Physicians
GI, Nutrition and Rheumatology
March 28, 2019
Early Bird:
Before March 8, 2019
Regular:
After March 8, 2019
Onsite:

For Nurses or Residents
GI, Nutrition and Rheumatology
March 28, 2019
Early Bird:
Before March 8, 2019
Regular:
After March 8, 2019
Onsite:

For Others
GI, Nutrition and Rheumatology
March 28, 2019
Early Bird:
Before March 8, 2019
Regular:
After March 8, 2019
Onsite:

For Invited Speakers
Click if you are an invited speaker



Cancellation Policy

Refunds, less an administrative fee of $25.00, will be made for written cancellations received before March 8, 2019. No refunds will be issued for cancellations received after this date.


 I have read and acknowledge the cancellation policy.



F. Method of Payment

  Total Amount : $

Online Credit Card Payment (VISA, Mastercard, Discover, American Express, Diners Club, Carte Blanche, JCB and Visa Debit)
Certified Cheque/Money Order/Bank Draft
(Please make payable in Canadian funds to "O'Donoughue & Associates Event Management Re : Pediatric Courses")
Credit Card Payment by Fax