Garrod Symposium Registration

GARROD ASSOCIATION / ASSOCIATION GARROD
CANADIAN ASSOCIATION OF CENTERS FOR THE MANAGEMENT OF HEREDITARY METABOLIC DISORDERS
ASSOCIATION CANADIENNE DES CENTRES DE TRAITEMENT POUR LES MALADIES MÉTABOLIQUES HÉRÉDITAIRES
Association des médecins généticiens du Québec
MEETING REGISTRATION FORM
AMGQ/Garrod joint meeting 2013
“Inborn Errors of Metabolism: From Clinical Translational
Research to Clinical Applications.”
NAME (as in membership registration form) :_______________________________________
(Please Print)
Fees
Registration type
th
(until April 15 )
(after April 15th)
2013 Garrod Membership application/renewal dues
$ 30
$ 30
Full or Associate member attending dinner
$ 120
$ 150
Genetic counselors attending dinner
$ 60
$ 75
Students and trainees attending dinner
$ 60
$ 75
$ 100
$ 120
$ 75
$ 75
Invited guest to dinner (maximum one per member)
Name of guest :
Optional activity on Saturday: Bishop’s University
(Musical Concert) : Member attending meeting or invited
guest (only one/member)
Name of guest :
Sub-total
(If spaces allow)
TOTAL
*** Please note any dietary requirements/allergies.
Cheques payable to “Garrod Association or AMGQ Association, depending on your affiliation”
 Please return this form + membership form + your cheque to the address below.
Sandrine Guillot
2, Complexe Desjardins,
Tour de l’Est, porte 3000
Casier postal 216,
Montréal (Québec) H5B 1G8
Please contact Sandrine Guillot regarding any questions about the registration: [email protected]