Contact Information
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Prefix : | |
First Name*: | |
Last Name*: | |
Hospital / Institution : | |
Position and/or Title*: | |
Business Address*: |
| Street Address* |
| | City* | Province / Territory / State | | Postal/ZIP Code* | Country* |
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Email*: | |
Email (verify)*: | |
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Tel. Number : | |
| Registration Options Conference Date: November 21, 2023 - Morning in-person Leadership Program: (CAD) $500.00 plus tax (selected candidates only); - Afternoon Virtual Event: (CAD) $450.00 plus tax; - Networking Dinner: (CAD) $175.00 plus tax; All delegates are expected to settle outstanding payments no later than November 17, 2023. Any delegates registering after the November 17, 2023 deadline must settle payments immediately. An email will be sent to all PAID registrants at least one business day prior to the webcast with all necessary details and links. Cancellation Policy: No cancellations. Registrations may be transferred to another person at no cost. If this is necessary, please contact us to register such change: SREMI. SREMI reserves the right to cancel or reschedule the event.
Select all that apply:
(selected candidates only)
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Submit (or Update) your selections to access the payment section appended at the bottom of the form.
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Chelsea Hotel booking instructions will be provided in the confirmation email to be sent by FiCare staff. Do not use any third party hotel booking company (e.g. Expedia, Hotels.com etc). | |
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Dietary Restrictions and Other Comments
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Dietary Restrictions
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Comments: | |