The Ottawa Quality & Patient Safety Conference

* Indicates Response Required.

* First name: * Last name:
* Organization:
* Department:
* Email Address:
Street Address:
City: Province:
Postal Code: * Daytime Phone number and extension:

* Occupation (must choose one):
MD
RN
RPN
OT
PT
Pharmacist
Researcher
Other (please specify)

* First time attending The Ottawa Hospital Patient Safety Conference:

* Meal Preference:
None
Vegetarian
Gluten-Free
Other

* Payment Type
External Registrants - Credit Card (MasterCard, Visa)
TOH, Bruyère, QUILT & RGPEO Staff - Credit Card (MasterCard, Visa)
TOH Staff - Cost Centre (TOH Staff Only)

Other Comments:

Cost of registration is $140 for TOH, Bruyère, QUILT and RGPEO staff and $160 for external registrants.