Online Conference Registration

TWH Anesthesia Preceptorship (PRE2010)

Welcome to the online registration page for the Toronto Western Hospital Anesthesia Preceptorship (PRE2010). Please follow these steps to complete your registration.

1.	Fill in your Personal Information (Step One) and click the "submit" button when completed to take you to your "Registration Confirmation" page
2.	From your "Registration Confirmation" page please follow the link to proceed to the "Payment Information" page.
3.	Complete all Payment Information fields (Step Two)
4.	Click the "submit" button at the bottom of this page. For your payment to be procesed

Please Note: your registration will not be considered complete until you provide your payment information.

Need help completing this form? Please contact
Christine Drane at 416-603-5118 or christine.drane@uhn.on.ca

Step One - Your Information
ALL FIELDS WITH * MUST BE COMPLETED

Personal Data:
Title (Occupation)*
First*			Last*
Your Contact Information:
Organization/ Co. Name*
Mailing Address*			Email Address*
			Tel*	Ext
Country			Fax

Scrub Suit Size			Top	Bottom



Choose Your Package Please indicate your preference below. Click here to view complete details for this course.
Package No. 1 (2 day visit)		Fee*
Available Dates for 2011		$375 CAN
	November 21-22
Package No. 2 (4 day visit)
Available Dates for 2011		$750 CAN
	November 21-24

*Please Note: your registration will not be considered complete until you provide your payment information.

Conference Contact Information: Contact Christine Drane at: 416-603-5118 or christine.drane@uhn.on.ca

Please ensure that you have completed all fields before clicking the submit button

Online Conference Registration

TWH Anesthesia Preceptorship (PRE2010)

Package No. 1 (2 day visit)

Fee*

Package No. 2 (4 day visit)

Package No. 1
(2 day visit)

Package No. 2
(4 day visit)