Ultrasound Guided Regional Anesthesia

Toronto Western Hospital Visit Program

University of Toronto

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 * Full Address City State/Province Country Postal/Zip Code Telephone Telefax * E-mail * Special Meal Requirement Scrub suit size Top Bottom II. Registration Fee Continuous Nerve Block Workshop Available Dates for 2010 Please select date October 29, 2010 Continuous Nerve Block Workshop Available Dates for 2011 Please select date January 28, 2011 February 25, 2011 June 17, 2011 November 4, 2011

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