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Registration Form
Prevention in Renal Disease

  October 1-2, 2010
  Westin Prince Hotel, Toronto

For a print out of the registration form please click here.

Delegate Information (complete one form per delegate)

* Mandatory Field

First name*     Last name*   

Address*    

City*    

Province/State*    

Country*    

Postal/Zip Code*    

For telephone and fax numbers, please include country and area codes:
Telephone*    

Fax    

Email*    

Principal specialty    

Institutional affiliation    

Degree    

Dietary restrictions    


Registration Fees Early Rate
(before Sept. 6)		 Regular Rate
(Sept. 7 - 25)		 Onsite Rate
(from Sept. 26 onward)
Physicians $375 $400 $425
Residents & Fellows
in training**		 $250 $275 $300
Allied health care professionals
(pharmacists, nurses, etc.)		 $250 $275 $300
Others $525 $575 $625


**A letter of verification from Department Chairman must accompany application for reduced fee

*    
Maximum file size: 10 Mb.

Registration Fees are in Canadian currency and include 5% GST - GST # 88624 5422 RT0001


 
  
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Prevention in Renal Disease