Register

Please contact HayMatick at 778-882-4389 or info@haymatick.com for any questions regarding registration.

REGISTRANT INFORMATION:
(* = required field)

* Dr. Mr. Mrs. Ms.

*Last Name

*First Name

*Address

*Institution/Hospital/
Clinic

*City

*State/Province

*Zip/Postal

*Country

*Telephone

*Email

*Specialty

Are you a Fellow/Resident?

YES NO

Are you an Allied Health Professional? (nurse or pharmacists)

YES NO

*If you have SPECIAL DIETARY NEEDS,
please indicate your requirements

Canadian Lung Cancer Conference shares a Canadian Lung Cancer Conference participant list with Silver to Platinum sponsors that includes the participant's name, specialty and city. Please check the box below if you DO NOT wish to have your information included on this participant list:

I DO NOT CONSENT to being on the participant list

ACCOMMODATION:

Canadian Lung Cancer Conference 2018 has negotiated a discounted room rate of $259/night. Please book your room at the link below while rooms are still available.

To book your accommodation directly with Fairmont Pacific Rim click here.

PLEASE RSVP:
Will you be attending the Canadian Lung Cancer Conference Opening dinner on Thursday Feb 8th at the Fairmont Pacific Rim?		YES NO
Will you be attending the Canadian Lung Cancer Conference Closing dinner on Friday Feb 9th (Location TBA)?		YES NO

REGISTRATION FEES:

Early Bird Registration until January 25th, 2018
General Registration fee is $275. Registration Fee for Nurses, Pharmacists, Fellows and Residents is $150.

After January 25th, 2018
General Registration fee is $375. Registration Fee for Nurses, Pharmacists, Fellows and Residents is $200.

Registration fees collected by HayMatick on behalf of Canadian Lung Cancer Conference

PAYMENT INFORMATION:

PAYMENT BY Credit Card (VISA, MasterCard or American Express):
We are using SSL (Secured Socket Layer) encryption technology to protect your credit card information during transmission

Credit Card:	VISA MasterCard American Express
Credit Card Number:
Your credit card number must not contain spaces.
Expiry Date:
CVD (3-4 digit code)
Cardholder Name:
Payment Amount:	$375

PAYMENT BY CHEQUE:
PLEASE MAKE CHEQUE PAYABLE TO "HayMatick Meetings & Events"
PAYMENT BY CHEQUE CAN BE MAILED IN ADVANCE TO:

HayMatick Meetings & Events
#202-5525 West Boulevard
Vancouver, BC V6M 3W6

Refunds, full or partial, will not be issued within 14 business days of conference.