Register for CLCCO 2023

Please contact HayMatick at 778-882-4389 or info@haymatick.com for any questions regarding registration.

PLEASE NOTE: ONLY INDUSTRY THAT ARE SPONSORING THE CONFERENCE MAY REGISTER.
CONFERENCE IS NOT OPEN TO NON SPONSORING INDUSTRY

REGISTRANT INFORMATION:
(* = required field)

* Dr. Mr. Mrs. Ms.

*First Name

*Last Name

*Institution/Hospital/
Clinic

*Address

*City

*State/Province

*Zip/Postal

*Country

*Telephone

*Email

*Specialty

*Are you a Fellow/Resident?

YES NO

Are you an Allied Health Professional? (nurse or pharmacist)

YES NO

*If you have SPECIAL DIETARY NEEDS,
please indicate your requirements

ACCOMMODATION:

Click here for more information regarding accommodation.

*Would you like to be notified of other upcoming education events?		YES NO
PLEASE RSVP:
*Will you be attending the Canadian Lung Cancer Conference Opening dinner taking place on Thursday February 2nd at the Fairmont Pacific Rim?		YES NO
*Will you be attending the Canadian Lung Cancer Closing Dinner taking place on Friday February 3rd at Riley's Fish and Steak?		YES NO

REGISTRATION FEES:

Early Bird Registration until January 5th, 2023:
Physician registration $300
Allied Health Prof., Residents and Fellows registration $200

After January 5th, 2023
Physician registration $400
Allied Health Prof., Residents and Fellows registration $250

Registration fees collected by HayMatick on behalf of Canadian Lung Cancer Conference

PAYMENT INFORMATION:

PAYMENT BY Credit Card (VISA, MasterCard or American Express):
We are using SSL (Secured Socket Layer) encryption technology to protect your credit card information during transmission

Credit Card:	VISA MasterCard American Express
Credit Card Number:
Your credit card number must not contain spaces.
Expiry Date:
CVD (3-4 digit code)
Cardholder Name:
Payment Amount:	$400

PAYMENT BY CHEQUE:
PLEASE MAKE CHEQUE PAYABLE TO "HayMatick Meetings & Events"
PAYMENT BY CHEQUE CAN BE MAILED IN ADVANCE TO:

HayMatick Meetings & Events
#202-5525 West Boulevard
Vancouver, BC V6M 3W6

Refunds, full or partial, will not be issued within 14 business days of conference.