TAILOR 2016

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REGISTRATION FORM
REGISTRATION INFORMATION
Name First Name      Last Name
University Affiliation
Address Address Courier address (no P.O. boxes please)
  City      Province/State      Country      Postal/Zip Code
Telephone Cell      Business
Fax
Preferred Email
REGISTRATION FEE (includes hotel accommodation and dinner)
Payment to be by cheque only*
$100.00 Physician
Enter Number of Spouse/Guests
$50.00 Enter Number of Child(ren)
Free Nurses    Fellows    Students    Residents    Other
Total
$
*Please make cheque payable to University of Calgary, c/o TAILOR Meeting 2016
Mail to Geraldine Tanis at 3280 Hospital Drive NW, TRW building, 6th floor, Calgary, Alberta, T2N 4Z6
HOTEL RESERVATION (click here for more hotel information)
To reserve a room click here: University of Calgary TAILOR Meeting
All incidental charges (e.g, mini-bar, laundry, telephone etc.) and room upgrade will be the guest's responsibility.
Please check if hotel is NOT required
For ROOM UPGRADES and SPECIAL REQUESTS: Please contact the Banff Centre at 403-763-6712 or 1-877-760-4595
GROUP DINNER*
Yes   No Friday, September 16, 2016 at 7:00 pm
Yes   No Saturday, September 17, 2016 at 7:00 pm
*Dietary restrictions (please specify):
 
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