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Registration Form

Evidence to Practice: Maximizing Our Investment in Health Care
2011 CADTH Symposium
April 3-5, 2011
Hyatt Regency, Vancouver, British Columbia

REGISTRATION FORM

Note: The Canadian Agency for Drugs and Technologies in Health (CADTH) retains the information on this form to send notifications and announcements about its activities and does not disclose registration information to third parties. However, to facilitate networking, CADTH does provide a list with names and organizational affiliations of all Symposium participants as a courtesy. By registering for this event, you are providing consent to CADTH to be included on this list. For credit card payments, your transaction information will be provided to a merchant service provider to process your registration fee payment.

Registration deadline: March 21, 2011 – or until event capacity has been reached. Registrations will be acknowledged by e-mail within two business days.

Participants are responsible for the cost of their travel arrangements and hotel.

The Symposium registration fee includes:

Admittance to Welcome Reception and Scientific Poster Viewing on Sunday, April 3.
Access to all Plenary and Concurrent Sessions on April 4 and 5.
Breakfast, lunch and refreshment breaks on April 4 and 5.
Dinner on April 4.
Complete delegate package including Symposium program and other materials.

Fields marked with an asterisk (*) are required fields.

Participant Category *

Other (Specify)

Which best describes you / your organization? *

Salutation

First name *

Last name *

Title *

Organization *

Department

Mailing Address 1 *

Mailing Address 2

Mailing Address 3

City *

Province/State *

Other Province/State (Specify)

Postal/Zip Code *

Country

Telephone *

- - Extension:

Fax

- -

E-mail *

In which official language should CADTH communicate when contacting you about this registration?

English French

Dietary restrictions, allergies, or special needs? If yes, please describe:

EVENT FEES

Welcome Reception and Poster Viewing - Sunday, April 3 - Evening

	Kindly confirm your attendance for the Welcome Reception	No charge

Symposium Sessions - Monday, April 4 and Tuesday, April 5

		Registration after Feb. 19, 2011 (plus applicable taxes)
	Standard Registration	$900.00
	Canadian Publicly Funded Health Sector (Government, University, Health System, Drug Review/HTA Agencies)	$475.00
	Canadian Publicly Funded Health Sector in CADTH Member Jurisdictions* (Government, University, Health System, Drug Review/HTA Agencies) * CADTH Member Jurisdictions are: AB, BC, MB, NB, NL, NS, NT, NU, ON, PE, SK, YK, and Government of Canada	$375.00
	Students	$200.00
	Representatives of patient groups	$200.00
	Registered for Sunday Workshop(s) only. I am unable to attend the sessions on April 4 and April 5.	N/A

Workshops - Sunday, April 3

The Workshop registration fee includes:

Full or Half day workshop and all appropriate handouts.

	I will attend one half day workshop (Morning OR Afternoon)	$125.00
	I will attend a full day or two half day workshops (Morning AND Afternoon)	$200.00

Symposium Dinner - Monday, April 4

Kindly confirm your attendance for the Symposium Dinner The registration fee includes dinner.	No Yes
Main course options for yourself: Beef Vegetarian
Additional Dinner Tickets ($85.00/each)
Main course options for your first guest: Beef Vegetarian
Main course options for your second guest: Beef Vegetarian
Main course options for your third guest: Beef Vegetarian
Main course options for your fourth guest: Beef Vegetarian

Event Fees

Sub-total
GST (5%)
Total

Payment Option (select either credit card or cheque)

Credit Card

Credit card number (do not include spaces):
Expiry date (mm/yy):	/
Name (as it appears on card):

Cheque payable to "CADTH" (an invoice will follow by e-mail with your registration confirmation. Full payment is requested by March 1, 2011.)

For additional information, please contact: Donna Lachance, Symposium Coordinator
Tel: (613) 745-8598