RSVP FORM by JaymesChapman

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                                RSVP FORM
                       Please return by August 15, 2009
To:             Anita Di Loreto                 Fax #:          905-527-4440


        Knowledge Translation Event for Integrating family
        Medicine and Pharmacy to Advance Primary Care
                    Therapeutics (IMPACT)

                                   October 1st, 2009
                               Leslie Dan Faculty of Pharmacy
                                    University of Toronto
                                     144 College Street
                                   Toronto, ON M5S 3M2

Name:

Organization:

Address:

City:                           Province:                       Postal Code:

Phone:                          Email:

Yes, I will attend

No, I cannot attend

PAYMENT: Registration fee of $150.00 by September 4, 2009.
Cheques to be made payable to St Joseph’s Healthcare and mailed to:
Anita Di Loreto, McMaster University, Department of Family Medicine, 75 Frid Street, T-30,
Hamilton ON L8P 4M3

								
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