Canadian Gene Cure Foundation
Foundation Canadienne Géne Cure 

Are you a: Please Select Principal Investigator Post Doctoral Fellow/Trainee Sponsor Other

Salutation: Dr. Mr. Mrs. Ms. Prof.

First Name:

Middle Name:

Last Name:

Position/Title:

Institution:

Department:

Mailing Address:

City:

Province:

Country:

Postal Code/Zip Code:

Telephone:

Fax:

Email:

Dietary preferences/restrictions:

Post Doctoral Fellow & Trainees

Mentor:

Current Research:

Title of Research Program:

Areas of Expertise:

Keywords for research projects and expertise:

A. I will attend the entire CHGC from April 18 – 21, 2010

B. I will attend the CHGC for the following days/nights:

Do you require accommodations?
A. Accommodations are required.
B. Accommodations are not required.

Preferred Roommate:

Please select one of the following:

A. Bus Transportation is not required.
B. Bus transportation is required departing from McGill University on April 18th at 3pm
C. Bus transportation is required departing from Pierre Elliot Trudeau Airport (departing on April 18th at 4pm and 5:30pm - bus number will be assigned)

Abstract to be submitted?

Yes
No

I agree to allow my poster/summary, contact information and picture to be posted on the Canadian Gene Cure Foundation -Canadian Human Genetics Conference Website.

Yes
No

I agree to allow my abstract to be part of my registrant profile in the meeting’s Program and Abstract Book

Yes
No

I am interested in: Please select one of the following Please Select Sleigh Ride (April 20, 2010) Sugar Shack Dinner (April 19, 2010) Alpine Skiing (April 20, 2010) Alpine Coaster Ride - The Viking (April 18th) None of the above