Registration Form

A. Identification


Medical Speciality:
Professional License Number

B. Special Needs

D. Registration Fees

For Physicians
Immunization Update for the Clinician
June 14, 2019
Early Bird:
Before May 10, 2019
Regular:
After May 10, 2019
Onsite:

For Nurses or Residents
Immunization Update for the Clinician
June 14, 2019
Early Bird:
Before May 10, 2019
Regular:
After May 10, 2019
Onsite:

For Others
Immunization Update for the Clinician
June 14, 2019
Early Bird:
Before May 10, 2019
Regular:
After May 10, 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 May 10, 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