MD Conferences - Registration Page - October 2007 Medical Mediterranean Conference

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October 1 - 12, 2007 MD Conferences
Online Registration

[note: this page is from the 2007 conference, information on the 2009 conference coming soon...]

You may submit registration information online below, or you can provide it over the phone when booking cabins. If you submit registration online (below), you will be contacted soon afterwards for completion of cabin bookings.

Fields marked with * must be filled before online form can be submitted (you will receive an error message if attempting to submit form without these fields being completed, and you will need to use the "Back" button on your web browser to return to this page to complete the necessary information).

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Please ensure accuracy of contact information in order for us to reach you.

Please enter a valid e-mail address where you can be contacted (if you do not have an e-mail address, you may still use this form by entering "info@mdconferences.com" in the field below and we will contact you using other contact information provided).

E-mail address:
Registrant Name (as in passport):
Professional Designation:
If "Specialist" or "Other" above, please provide details:
Nationality (as on passport):
Date of Birth (yyyy-mm-dd):

Address:		City:
Province / State:		Country:
Postal / Zip Code:
Phone:		Fax:

*How did you hear about the conference?*

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TRAVELLING COMPANIONS in same cabin (names as they appear in passports)

Please note: If nationality for any travelling companions is DIFFERENT from that of registrant, please indicate this in the "Comments" field at bottom, otherwise it will be assumed that all travellers are the same nationality as registrant. If more than 4 travelling companions, please write additional companions information in "Comments" field at bottom.

Companion 1 - Name:		DOB:
Companion 2 - Name:		DOB:
Companion 3 - Name:		DOB:
Companion 4 - Name:		DOB:

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Cabin preference - first choice:
Cabin preference - second choice:
Dinner seating preference:
Medical and/or Travel Insurance (recommended):

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Base Registration Fee: (in Canadian dollars; no GST)
Optional "CME To Go" Program Fee:
If eligible for "Attend with a Colleague" $75 deduction, enter Colleague name:

Please note: Spousal / Resident Registration does not qualify for "Attend with Colleague" discount.

Complete next three boxes only if there is a second registrant in the same cabin (i.e. if one of the travelling companions listed above is also a registrant).

Name of Second Registrant:
Second Registrant Professional Designation:
If "Specialist" or "Other" above, please provide details:
Second Registrant Registration Fee (*"Attend with Colleague" Discount already applied):

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Please check box below to confirm you have read the "Term & Conditions" for the October 2007 MD Conferences meeting:
[click here to open new window to view"Terms & Conditions" page]

*Yes, I have read the Terms and Conditions for this conference:*

Comments:

Registration may be paid by credit card (Visa, Mastercard), or may be paid by cheque made payable to "MD Conferences".

Space cannot be held until registration is complete and payment received.

Information submitted will be shared with Marlin Travel to facilitate bookings, and may also be used to keep you informed of future CME events.