Registration: Family Planning Update

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 25, 2017. 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

Family Physician
Ob/Gyn
Nurse Practitioner
Nurse
Resident/Fellow
Student
Other

Other profession Please specify

Please rank your workshop preferences from 1 through 3:

Participants will attend ONE of the following concurrent workshops during the afternoon session from 1:40 - 2:40 p.m.

IUCD - Hands on Demonstration and Instruction
Hands-On: Diaphragms and Caps
There are no stupid questions...ask us!

Workshop A

Workshop B

Workshop C

Payment Amount

Fee Group	Early Fees (on or before October 25, 2017)	Late Fees (after October 25, 2017)
Physician	$225+HST = $254.25	$250+HST = $282.50
NP / Nurse / MW	$175+HST = $197.75	$200+HST = $226.00
Resident / Student / Fellow	$100+HST = $113.00	$125+HST = $141.25

I will be submitting the following fee:

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Registration: Family Planning Update