Registration Form

A. Identification


Medical Speciality:
Professional License Number

B. Special Needs

C. Workshop Preferences

ANNUAL SPECIALTY DAY: Pediatric Respirology
February 13, 2019
SESSIONS I & II
Please rank the workshops in order of preference (1 to 3). You will be assigned to 2 workshops on a first-come, first-reserved basis.
Choice: Workshop Name:
Dyspnea
Recurrent Pneumonia
Excessive Daytime Sleepiness
SESSIONS III & IV
Please rank the workshops in order of preference (1 to 3). You will be assigned to 2 workshops on a first-come, first-reserved basis.
Choice: Workshop Name:
Pulmonary Function Tests Interpretation
Functional Respiratory Problems
Asthma
PRACTICAL PROBLEMS IN PEDIATRICS
February 14, 2019
Please rank the workshops in order of preference (1 to 6). You will be assigned to 3 workshops on a first-come, first-reserved basis.
Choice: Workshop Name:
A Stitch in Time – Suturing 101 for the Office Setting  CLOSED
Baby Steps – When to Worry About the Lower Limbs
Pills Are Passé – Are IUDs the Future?
Clinical Exam Pearls in Child Protection
A Picture Is Worth a Thousand Words – Dermatology Potpourri
To Echo or Not to Echo? – That Is the Question.

D. Registration Fees

For Physicians
Pediatric Respirology
Feb. 13, 2019
Practical Problems in Pediatrics
Feb. 14-15, 2019
Both Courses
Feb. 13, 14, 15, 2019
Early Bird:
Before
Dec. 14, 2018
Regular:
After
Dec. 14, 2018

For Nurses or Residents
Pediatric Respirology
Feb. 13, 2019
Practical Problems in Pediatrics
Feb. 14-15, 2019
Both Courses
Feb. 13, 14, 15, 2019
Early Bird:
Before
Dec. 14, 2018
Regular:
After
Dec. 14, 2018

For Invited Speakers
Click if you are an invited speaker          

On-site registration*
.................... Pediatric Respirology
Feb. 13, 2019
Practical Problems in Pediatrics
Feb. 14-15, 2019
Both Courses
Feb. 13, 14, 15, 2019
After Feb. 1, 2019

A one-day registration for the Practical Problems in Pediatrics Course is $395. After Feb 1, 2019 one-day registration is $420.00.

Early Bird is before December 14, 2018. After December 14, 2018, prices revert to Regular.

*After February 1, 2019, registration will be done on site. On-site registrants will be assigned workshops on the basis of availability.





E. Meet the Expert


I wish to attend the following Meet the Expert lunchtime session(s) (cost $40 per session; space is limited; first-come, first served):

Thursday,
Feb. 14, 2019
Gastroenterology ... OR ...
Adolescent Medicine/Gynecology
Clear Entry
$
Friday,
Feb. 15, 2019
Infectious Diseases ... OR ...
Child Psychiatry  CLOSED
Clear Entry
$
Meet the Expert Fees: $

Cancellation Policy

Full refunds, less an administrative fee of $50.00, will be made for written cancellations received by January 11, 2019. After January 11, 2019, only 50% will be refunded, and no refunds will be issued for cancellations received after February 1, 2019.


 I have read and acknowledge the cancellation policy.



F. Method of Payment

  Total Amount (Registration Fee + Meet the Expert): $

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