CAG AGM Registration

ANNUAL GENERAL MEETING AND SCIENTIFIC SESSIONS

CAG AGM Registration

Select the most apropriate option:

Dr.

R.N.

Mr.

Ms.

Mrs.

First and Last Name

Institution

Street Address

City

Province

Postal code

Phone number

Email address

Name of accompanying dinner * $125 Extra per guest (non-delegate, if applicable)

Special requirements (diet/medical/halal)

I will be attending the Saturday night reception and dinner: (included in registration fee) *

Yes

Please select your choice of entree ( please note that if a selection is not made a vegetarian meal will automatically be selected for you)

Beef

Fish

Vegetarian

Guest Selection

Beef

Fish

Vegetarian

REGISTRATION FEE *

Nurses - C$275

Physicians - C$450

Other - C$450

Sponsors

Your Signature

Payment Options:

OPTION 1: E-TRANSFER to cag@cagcanada.ca

Please include your name and registration fee type (Physician, Nurse, Other).

OPTION 2: CHEQUE mailed to the Canadian Apheresis Group

CAG Mailing address: 150 Montreal Road, Suite 311 Ottawa, Ontario, K1L 8H2.

CAG AGM Registration

CONTACT DETAILS

PHONE

CANADIAN APHERESIS GROUP

613-748-9613

cag@cagcanada.ca

HEAD OFFICE

150 Montreal Road,

Suite 311 Ottawa,

Ontario K1l 8H2

FAX

613-748-6392

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