Online Registration Form

A. Identification

B. Perspective

Medical Speciality:
MD (in year:)

C. Registration Fees

FULL SYMPOSIUM REGISTRATION

Before Jan. 31, 2016 After Jan. 31, 2016 After April 22, 2016 TOTAL $
Physician / Pharmacist / Corporate
Genetic Counsellor / Nurse
$505 CAN $595 CAN $715 CAN
Post Doc. / Resident1
$480 CAN $570 CAN $680 CAN
Student2
$360 CAN $420 CAN $505 CAN

All fees are shown in Canadian funds. The Full Symposium registration fees includes access to sessions, continental breakfast each day, buffet lunch (May 11-12), coffee breaks, the Special Introductory Workshop and the Symposium documentation.

INDIVIDUAL DAY REGISTRATION

Before Jan. 31, 2016 After Jan. 31, 2016 After April 22, 2016                            
Physician / Pharmacist / Corporate
$390 CAN $415 CAN $450 CAN  
Genetic Counsellor / Nurse
$290 CAN $315 CAN $345 CAN  
Post Doc. / Resident1
$280 CAN $315 CAN $345 CAN  
Student2
$210 CAN $230 CAN $250 CAN  
$   X    Days =  
Special Intro Workshop
(Tuesday, 7 PM - 9 PM)
(already included in Full Symposium fees)
$50 CAN $55 CAN $60 CAN

1 Please provide proof of Post Doc / Resident status, i.e. letter from your programme director.

2 Please provide proof of full-time student status, i.e. copy of current student card or letter from your programme director.

Total Registration Costs

D. Special Interest Group (SIG) Preferences

Thursday, May 12, 2016

Please rank the SIGs in order of your preference (1-4). You will be assigned to one SIG on a first come-first served basis.

Panels: Mutations and VUS: Bring your own cases

NGS – beyond the basics and into the nitty gritty

Prostate and Pancreas cancer in high-risk families – Prevention, early diagnosis and treatment

Next-generation genetic counseling: Effective tools for promoting risk management adherence & psychosocial adjustment

E. Special Needs

F. Method of Payment

Online Credit Card Payment (VISA, Mastercard or American Express only)
Certified Cheque/Money Order/Bank Draft
(Please make payable in Canadian funds to "O'Donoughue & Associates Event Management Re : BRCA2016")
Credit Card Payment by Fax
I am an Invited Speaker

Cancellation Policy

Full refunds, less an administrative fee of $50.00, will be made for written cancellations received by February 21, 2016. After February 21, 2016, only 50% will be refunded, and no refunds will be issued for cancellations received after March 18, 2016.


 I have read and acknowledge the cancellation policy.