Workshops - Registration form
Ultrasound Guided Regional Anesthesia
Toronto Western Hospital Visit Program
University of Toronto
I. Registration Personal Data
Please complete all the fields marked with *
Title
* First Name
* Last Name
Clinic/Department/Organization
* Full Address
City
State/Province
Country
Postal/Zip Code
Telephone
Telefax
* E-mail
* Special Meal Requirement
Machine Requirement (BK Medical, GE, SonoSite, Zonare, Philips)
BK Medical
GE
Philips
Sonosite
II. Registration Fee
Workshops Available Dates for 2011
Please select date
February 11-13, 2011
October 21-23, 2011
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