DRUG THERAPY DAY 2025 REGISTRATION FORM

DRUG THERAPY DAY 2025 REGISTRATION FORM
Salutation:	Dr. Mr. Mrs. Ms.
*First name:**
*Last name:**
*Title:**
Department:
Organization:
*Email:**
*Phone:**
*Fax:**

REGISTRATION FEES:
$160	Early Bird Registration (February 1 to May 12, 2025)
$180	After Early Bird Registration (May 13 to June 11, 2025)
$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 payments will be processed by London Health Sciences Centre Research Institute (LHSCRI) Finance Department
Mastercard
Payment Submission Information:
Registration fee paid by credit card - LHSCRI Finance will contact you directly by telephone to process your credit card for payment Registration fee paid by cheque - must be made payable to London Health Sciences Center Research Institute – Drug Therapy Day 2025 and mailed to Jody Murray Drug Therapy Day 2025 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