Registration Option 3 DELEGATE REGISTRATIONDelegate Last Name*Delegate First Name*CSPO Number*Physician Billing Number*SpecialtyFamily PhysicianCardiologistInternal MedicineOB/GYNOtherMain Practice Location (City or Town)*Room Date*Friday + Saturday NightRoom Preference*2 Queen Beds1 King BedFood Allergies SPOUSE/PARTNER REGISTRATIONSpouse / Partner*YesNoSpouse Last Name*Spouse First Name*CPSO Number (if applicable)Physician Billing Number (if applicable)SpecialtyNot ApplicableFamily PhysicianCardiologistInternal MedicineOB/GYNOtherMain Practice Location (if applicable)Food Allergies BILLINGBilling First Name*Billing Last Name*Email Address* Phone Number*CME Option 3 Price: $ 650.00 CAD Total Cost $ 0.00 CAD Choose your payment method:Credit CardChequeEmailThis field is for validation purposes and should be left unchanged.
