TLC Application

Please note: Once you have applied for TLC your name will be submitted to the TLC Chairs for consideration. TLC Chairs, Dr. Sangha and Dr. Baker, will confirm accepted candidates by mid-December. After receiving participation approval, you will be requested to register for the Canadian Lung Cancer Conference as well.
This application IS NOT a registration form for the Cdn Lung Cancer Conference

Please contact HayMatick at info@haymatick.com for any questions regarding this application.

APPLICANT INFORMATION:

First Name *

Last Name *

Email *

Specialty *

Please Specify

Residency Location/Hospital *

Province *

Please Specify

Program Director *

Training Level PGY *

Please Specify

Have you attended TLC in the past? *

Yes No

If yes, what years?

Are you aware of the Betty Rice Award? *

For information on the Betty Rice Awards please click here.