Online Conference Registration

Ultrasound for Pain Medicine Workshop (USPMW)

Welcome to the online registration page for the Ultrasound for Pain Medicine Workshop (USPMW). 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

Your name:
	Title (Occupation)*

	First*
	Last*
Your Contact Information:
	Organization/Co. Name*
	Mailing Address*
	Email Address*
	Telephone*	Ext	Fax

Choose Your Workshop Date Please indicate your preference below. PLEASE NOTE - THE COST FOR THIS WORKSHOP IS $1,200 CDN. The fee for the optional day is $150 CDN.
Workshops - Available Dates for 2011

Sept. 30, 2011 (optional)			view program
Oct. 1 -Oct. 2, 2011			view program
Do you have any special menu requirements?
Workshop 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