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University
Street Address 1*
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**You will receive a confirmation email shortly after submitting this form.

Send a cheque or money-order (payable to "Basic Science Course") to the following address:

Debbie Morris, Course Administrator
1401 Duford Drive,
Orleans, Ontario
K1E 1E4

Registration fees are as follows:
All attendees: $1400.00

Upstate Medical University
Course Director

Residency Program Director
University of Alberta
Western Course Coordinator

Walter Stirling Anderson Professor
Chair, Department of Surgery
The University of Alberta
Western Course Coordinator

St. Agnes Hospital,
Course Consultant,
Pathology and Educational Resources

G. Victor Rohrer Professor of Radiology Education,
Radiology Residency Program Director,
Vice Chair for Education

University of Toronto,
Educational Consultant

University of Western Ontario,
Consultant on Testing and Participant Evaluation