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REGISTRATION                                  Click here to report a problem

I. Registration Personal Data

* The registration will be processed once full payment has been received.

Please Complete All The Fields Marked With *
Title:
  
* First Name:
* Last Name:
Department/Organization:
  
* Full Address
  
* City
State/Province
* Country
  
Postal/Zip Code
  
Telephone No.
Fax No.
* Email Address
Special Meal Requirement
  

II. Registration Fee

Register me for:

Ultrasound for Regional Anesthesia [FULL]

* Please email Christine Drane to be added on the waiting list. *
Full Course ($750.00) - Info
June 4 & 5 ($600.00) - Info
June 6 ($300.00) - Info

Ultrasound for Chronic Pain
Full Course ($800) - Info


Social Events
I confirm my presence at the Welcome Reception (Saturday June 5) The Welcome Reception is free for registered delegates but pre-registration is mandatory.
Gala Dinner ($100) - Info
person(s)
Please choice one of the following main course:

 



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