TITLE	SURNAME	FIRST NAME
ADDRESS
CITY	PROV/STATE	POSTAL CODE
DAY TELEPHONE		FAX NUMBER
EMAIL
SPECIALTY/HOSPITAL/FACILITY
AB COLLEGE REGISTRATION #

PARKING(cannot guarantee after registration deadline)

YES, required

NO, not required

METHOD OF PAYMENT Send Cheques to: Continuing Medical Education 2J3 Walter Mackenzie Centre, University of Alberta Edmonton, Alberta T6G 2R7	VISA	MASTERCARD	CHEQUE payable to University of Alberta
For Payment by Credit Card, please phone in your information at 780-407-6346 or fax it in at 780-407-1442.
AMOUNT Before October 6th, 2002 General Physician $250 Specialist $250 Resident/Allied Health Professional $250 Pharmacist $250		AMOUNT After October 6th, 2002 General Physician $275 Specialist $275 Resident/Allied Health Professional $275 Pharmacist $275
Registration Fees:(includes course material, continental breakfasts, refreshment breaks, lunches and parking)