COURSE DETAILS

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Deadline for Registration: October 18th, 2002
(Course material cannot be guaranteed after this date)

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

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 at (780)407-1442.
Registration Fees(includes course material, continental breakfast, lunch, refreshment breaks and parking)
before Oct 11th                                                 after October 11th $100            Full Day Fee            $150 $75            Half Day Fee            $95 $40    Residents/Interns/Students    $80