2016 AGM Registration Form (Members)

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If you are a Non-member
please register here:

Non-member Registration

2016 Annual General Meeting Registration Form

Members

Wednesday, June 1, 2016
Fairmont Chateau Laurier Hotel,
1 Rideau Street, Ottawa  K1N 8S7

    Salutation / Salutation (required)

    First Name / Prénom (required / champs requis)

    Last Name / Nom (required)

    Title / Titre du poste (required / champs requis)

    Riding or Location, or Organization / Circonscription électorale ou localité, ou organisation (required / champs requis)

    Email Contact / Adresse de courriel (required/ champs requis)

    Phone Number / Numéro de téléphone (required / champs requis)

    I will attend the Virtual Reception / J'irai au réception virtuelle (required / champs requis)

    I give permission for my name to be shared as a participant in this event / Je donne la permission que mon nom soit partagé en tant que participant à cet événement (required / champs requis)

    I would like to subscribe to receive updates by email about health research and innovation in Canada and future PHRC events / J'aimerais m'inscrire pour recevoir des mises à jour par courriel sur les nouvelles de la recherche et de l'innovation en santé et les événements futurs du PHRC (required / champs requis)

    Do you have a question for the Panelists? Avez-vous une question pour les panélistes?

    A block of rooms has been set aside at the Fairmont Chateau Laurier Hotel for your convenience at a special rate of $239.00+Tax (Fairmont Room). We encourage you to book your room as soon as possible. You may make your reservations online by going to

    The Fairmont Chateau Laurier Hotel Research Canada RegistrationPage

    The deadline to obtain this rate online would be April 30, 2016 after which you will have to call the hotel to make the reservation.  Alternatively, the hotel can be reached directly at 1-800-441-1414. For ease of booking, please identify yourself as being with our group: Research Canada.

    To confirm attendance, please register

    prior to May 9, 2016 

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