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Registration: Infectious Diseases in Obstetrics & Gynaecology

Registration includes attendance at all lectures, syllabus, CME credits, continental breakfast, lunch and coffee breaks.

Cancellations: Refunds will not be issued for cancellations received after October 20, 2015. A processing fee of $40 will be retained on all cancellations.

Contact Information

Title

First Name

Last Name

Facility or Organization Name

Mailing Address

Unit, Suite, or Apartment

City

Province / State

Country

Postal / Zip Code

Business Phone

Fax

Your E-Mail Address

Please indicate your profession:

Profession Please select one

Nurse
Nurse Practioner
Student
Resident
Family Physician
Obstetrician/Gynaecologist
Other

Other profession Please specify

Payment Amount

Fee Group	Early Fees (on or before October 20, 2015)	Late Fees (after October 20, 2015)
Physician	$225	$250
Nurse & Health Care Professionals	$175	$200
Resident/Students/Fellows	$100	$125

I will be submitting the following fee:

I will be paying by: Please note: registration will not be complete until payment is received.

Credit Card (through PayPal)

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