providence health care - registration deadline and ... · web viewcancellations received on or...
TRANSCRIPT
2020 PHC Ethics Education EventsRegistration Form
Participant Information
Name Click here to enter text.
Title Click here to enter text. Site/Unit Click here to enter text.
Department Organization Click here to enter text.
Mailing address Click here to enter text.
2020 PHC Ethics Education EventsRegistration Form
Email Click here to enter text. Phone Click here to enter text.
Food allergies Click here to enter text.
How did you hear about this event? Click here to enter text.
Innovating failure: Ethical issues on the path to health care advancementFriday April 24 2020, 8:00 am - 4:00 pm Morris J Wosk Centre for Dialogue, 580 W Hastings Street, Vancouver, BC
☐ $50 for PHC staff/physicians
2020 PHC Ethics Education EventsRegistration Form
☐ $125 for non-PHC staff/physicians (includes breakfast, lunch, snacks)
Method of Payment
Amount $ Click here to enter text. MC/VISA Click here to enter text.
Credit Card # Click here to enter text. EXPIRYClick here to enter text.
Cardholder name Click here to enter text.
Billing address Click here to enter text.
2020 PHC Ethics Education EventsRegistration Form
Signature Click here to enter text. Date Click here to enter text.
Cheque # Click here to enter text.
Cheques payable to Providence Health Care and mail to PHC Ethics Services, c/o St. Paul's Hospital, 1081 Burrard Street Vancouver, BC V6Z 1Y6
Registration Deadline and Cancellation PolicyRegistration Deadline: Friday April 17 2019
Cancellations received on or before April 10 2019 will be refunded the full registration fee less a $25 administration fee. No cancellation refund will be provided after April 17 2019.
2020 PHC Ethics Education EventsRegistration Form
Registration Contact: e: [email protected] p: 604-806-9853mail: PHC Ethics Services, c/o St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6www.providencehealthcare.org/ethics_services/