I. Registration Personal Data * Note: you must submit a copy of the most updated CV for Hospital observer privilege application. E-mail your CV to: christine.drane@uhn.on.ca or fax to 416-603-6494 Please complete all the fields marked with * Title * First Name * Last Name Clinic/Department/Organization Country * Full Address City State/Province Postal/Zip Code Telephone Telefax * E-mail Scrub suit size Top Bottom II. Registration Fee Package #1 (2 day visit) Canadian $ 375 Available Dates for 2010 November 1-2 December 6-7 Available Dates for 2011 February 14-15 March 7-8 October 24-25 November 21-22 Package #2 (4 day visit) Canadian $ 750 Available Dates for 2010 November 1-4 December 6-9 Available Dates for 2011 February 14-17 March 7-10 October 24-27 November 21-24

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