DRUG THERAPY DAY 2024 REGISTRATION FORM

DRUG THERAPY DAY 2024 REGISTRATION FORM
Salutation:	Dr. Mr. Mrs. Ms.
*First name:**
*Last name:**
*Title:**
Department:
Organization:
*Email:**
*Phone:**
*Fax:**

REGISTRATION FEES:
$160	Early Bird Registration (Jan 1 - May 10, 2024)
$180	After Early Bird Registration (May 11 – June 5, 2024)
$225	Onsite Registration (limited to 10 attendees)
$75	Student (with proof of being a student)
METHODS OF PAYMENT:
Cheque	Cheque must be mailed to our office. See payment submission information below.
Visa	Credit card information must be faxed to our office. See payment submission information below.
Mastercard
Payment Submission Information:
Registration Forms with credit card information - can be faxed to 519-663-3090 or call to Jody Murray at 519-663-3553 Registration Form with cheque - must be made payable to Lawson Health Research Institute – Drug Therapy Day 2024 and mailed to Jody Murray Drug Therapy Day 2024 LHSC – University Hospital 339 Windermere Road, Room B9-116 London, Ontario N6A 5A5 All inquires: Please contact Robin Legan, Event Coordinator by email – robin.legan@lhsc.on.ca