Registration Form

First name and Last name:

Title:MSc, PhD, MScPT, MScOT, Post-Doc, Other (please specify)

Email:

Institution:

Department:

Program of study:

I am registering for the Colloquium AND submitting an abstract.

I am registering for the Colloquium ONLY.

Refreshment breaks and lunch will be provided.

Please send your registration form as an attached Word document saved in the following format: lastname_firstname_regform.doc to rehabsci@queensu.ca

If you are submitting an abstract, please send your abstract and registration form as separate documents attached to the same e-mail.

Please indicate if you have any dietary restrictions: