CANPUG2012 Registration

Registration Form

The following registration form is for those wishing to attend GE CANPUG 2012. Each individual attendee must fill out a separate registration form. Field’s with (*) are required to be filled:

Name *This question is required.

Last Name *This question is required.

Hospital/Organization *This question is required.

Profession

Email Address *This question is required.

Admin Assistant e-mail This question requires a valid email address.

Mailing Address *This question is required.

Mailing Address 2

City *This question is required.

Province/State *This question is required.

Postal Code *This question is required.

Phone Number

* Our generous sponsors for the event may wish to contact our attendees via email. Please indicate whether you would like to be included:

Yes, please include me
No, Thank You

What days will you be attending the meeting? *This question is required.

If you have session topic/speaker suggestions please list below:

Please list any dietary restrictions below:

For detailed conference information visit our GE CANPUG website.

For accommodation reservations and discounts with the Radisson please call 416-203-3333.

Let them know you are making a booking for "CANPUG Conference" to ensure you receive the group rate.

Visit the hotel website to learn more about the facility. http://www.radisson.com/toronto-hotel-on-m5j2n5/ontoront

Please note: During the event Photographs and/or filming may be taken to be used for promotional use.

If you have any questions, please contact Zuzana Bleha:

Zuzana Bleha
Marketing Manager at
GE Healthcare IT Canada
T + 1 905 567 2123
+ 1 888 367 2773 x 2123
E-mail: zuzana.bleha@ge.com