PUA Registration


 

Arrival Thursday, March 3, 2011 :  Yes No
If no, when do you plan to arrive :
   
Name :
Spouse :
Children :  Yes No
   
Name Age Food Restrictions
   
Medical Student :  Yes No
If yes, list university :
   
Resident :  Yes No
If yes, list university and training program :
   
Surgeon :  Yes No
   
Industry Representative :  Yes No
If yes, list company :
   
Attending Friday Informal Buffet Dinner :  Yes No
How many Adults :
How many Children (12 & under) :
How many Youths (13 & older) :
   
Attending Saturday Annual Semi-Formal Dinner :  Yes No
How many Adults :
How many Youths (13 & older) :
   
Children Attending Saturday Evening Children's Dinner :  Yes No
(all children attending must have supervision)
   
Name Age Food Restrictions
     
Please Note: That babysitting must be prearranged by parents before arrival as The Chateau Lake Louise requires time to arrange childcare requests (1 800 441-1414).
   
* All the information below is required.
   
  Billing Information
   
Name :
Address :
City :
Province :
Postal Code :
E-mail :
Phone :
   
 


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