62nd Summer Educational Sessions
August 8-11, 2009 Delta Winnipeg Hotel & The Winnipeg Convention Centre
REGISTRATION FORM
The EARLY BIRD registration deadline is July 17, 2009. Registrations must be received online, post-marked or faxed on/ before July 17 to qualify. Cheques post-dated after July 17 will not be eligible for the early bird rate. After August 1, 2009, all registrations must be processed onsite. NSF cheques will be charged a $30 administration fee. CSHP Membership Number (optional) Name Job Title/Position Hospital/Faculty/Company Address City Telephone Province Email (required) Postal Code Ribbons for your Badge (check all that apply)
Emergency Contact (name and telephone number)
□ Council □ ESC Committee □ Fellow □ Mentor □ Past President □ Speaker □ Volunteer □ None
Full, Daily and Shared registrations include all educational sessions, exhibits, luncheons (Sun & Mon), course materials, name badges and registration kits.
• •
Poster presenters receive the early registration rate (full or daily). Shared (group) registrations allow up to 3 registrants to attend and can be used by one individual per day. If all registrants in the group are CSHP members, the shared member rate applies. If any registrant in the group is not a CSHP member, the shared non-member rate applies. Active-In-Training and Student registrants are not eligible for shared registrations.
Full Registration
Member Non-Member Active-In-Training Member Active-In-Training Non-Member
(postgraduate students and residents)
Until July 17
$550 $870 $320 $410 $320 $410 $220 $275
After/ Onsite
$650 $970 $375 $465 $375 $465 $265 $320
Daily Registration
Check day(s): Member Non-Member Active-In-Training Member Active-In-Training Non-Member
(postgraduate students and residents)
Until After/ July 17 Onsite
□ Sunday □ Monday □ Tuesday
$310 $395 $110 $150 $350 $455 $125 $170 $125 $170 $95 $105
Pharmacy Technician Pharmacy Technician Non-Member
(Member of CSHP or CAPT)
Pharmacy Technician $110 Pharmacy Technician Non-Member $150
(Member of CSHP or CAPT)
Student Member Student Non-Member
(undergraduate pharmacy students)
Student Member Student Non-Member
(undergraduate pharmacy students)
$75 $95
Shared (Group) Registration
Shared Member Shared Non-Member $630 $945 $740 $1055
Bonus Membership Offer
All full non-member registrants (or one shared non-member registrant) automatically receive a bonus CSHP membership for the 2009/2010 membership year! The membership year runs from July 1, 2009—June 30, 2010. Memberships will start in August 2009. No, thank you The name of the shared non-member who will receive the bonus CSHP membership is:
Please provide the name, title, and email address of the shared registrant beside each of the corresponding days: Sunday, August 9 Monday, August 10 Tuesday, August 11
□
.
The information you provide to CSHP such as your name, address and email address is used to notify you of issues, events, activities or special offers. From time to time, we make our membership list available to specific reputable companies or organizations whose products and/ or services may be beneficial to you.
□ Check here if you do not want CSHP to share your contact
information with other companies or organizations.
62nd Summer Educational Sessions
August 8-11, 2009 Delta Winnipeg Hotel & The Winnipeg Convention Centre
REGISTRATION FORM
Workshop & Social Events (Optional)—please refer to the SES program for session/event details.
Saturday, August 8
Fee
Qty
Total
Sunday, August 9
Fee
Qty
Total
□ CHPRB Workshop: Teaching Residents to Teach!
13:00—17:00 There is no charge to participate, and SES non-registrants are welcome to attend. Please check box if you plan to attend. Number of attendees:
□ 5 K Fun Run/3 K Walk Event 06:00—07:30
Complimentary event. Please check box if you plan to attend. Number of attendees:
□ Research & Education (R&E) Foundation
Fundraising Golf Event 08:00—16:00 (Event limit of 80 golfers) Green Fees $100 Club Rental (full set) $35 Transportation Required $ $
□ Fun Night 19:15—24:00
Early Bird (until Jul 17) After/Onsite Monday, August 10 Early Bird (until Jul 17) After/Onsite *Meal Preference $50 $55 $ $
Fee
$75 $80
Qty
Total
$ $
□
□ *Past Presidents’ Dinner & Dance 18:00—24:00 □ Bison (medium rare) □ Chicken □ Vegetarian
□ □ □ □Cheque payable to CSHP
For rentals specify:
□ L-handed □ R-handed
Green fees and club rentals are GST exempt.
□ Opening Reception 19:00—21:00
Complimentary event. Please check box if you plan to attend. Number of attendees:
Payment Information
Registration Fee Fun Night Past Presidents’ Dinner & Dance 5% GST # R106866940 R&E Foundation Golf Event R&E Foundation Donation (optional) Total ($Cdn) * GST Exemption # $ $ $ $ $ $ $
Card # Exp. date CCV# What is a CCV# ? Find out at http://www.eplyevents.com/library/infopages/ccv_info.html Signature
* Registration fees are subject to 5% GST. R&E Foundation donations are GST exempt. Tax receipts issued for R&E Foundation donations, Reg #087409-19. If purchaser is GST exempt, please provide exemption number or explanation.
Ways to Register
1. 2. 3. ONLINE at www.cshp.ca (by credit card or cheque) FAX your completed form to 613-736-5660 MAIL your completed form to: Canadian Society of Hospital Pharmacists 30 Concourse Gate, Unit # 3 Ottawa, ON K2E 7V7 CANADA
Cancellation/Refund Policy
Registrations may be cancelled in writing without penalty up to July 31, 2009. An administrative fee of $50 will be charged to cancel registrations from August 1-4, 2009. Registration fees will not be refunded for cancellations received after August 4, 2009.
Photo Release
By registering for the CSHP Summer Educational Sessions and its associated events, you have provided your release for the free use by CSHP for promotional purposes of any photographs taken of you or in which you may be seen during the meeting.
Enquiries?
You should receive confirmation by email within two weeks of registering. If you do not receive confirmation, please contact us. Registration enquiries may be directed to Robyn Rockwell, rrockwell@cshp.ca or 613-736-9733, ext. 222 General enquiries may be directed to Desarae Davidson, ddavidson@cshp.ca or 613-736-9733, ext. 229