Concurrent Disorders Conference Registration

Registration fee: $185.00 (Includes refreshments and lunch)

*Full-time student rate: $85.00 with student I.D. (Space limited)

Registration fees must be received by September 8, 2015

Cancellations without penalty will be accepted up to and including September 14, 2015 (Must be in writing). We regret we will be unable to refund registration fees after this date. We reserve the right to cancel this program due to insufficient registration or circumstances beyond our control.

Registration Form:

Please complete this form and send your cheque in the amount of $185.00 payable to William Osler Health System to:

Cora Edwards, Withdrawal Management Centre, WOHS
135 McLaughlin Rd. S.,  
Brampton, Ontario,  
L6Y 2C8 

Select a choice

References

Identify two people who would be willing to provide a reference to support your application. Please ensure they agree to be contacted.

I give permission to William Osler Health System to discuss my application with the person(s) listed as references. I understand and agree that to the best of my knowledge, the information I have provided is complete and accurate in every respect. Any material misrepresentation or deliberate omission of a fact in my application will be justification for refusal of the opportunity to volunteer, or if volunteering, just cause for termination from William Osler Health System. Information in this application may be made available to staff at William Osler Health System who are the leads (or designate) of activities that you are interested in participating. Informative emails may be sent to you and you may be contacted by telephone.

Your siganture