The University of British Columbia
UBC - A Place of Mind
The University of British Columbia
Faculty of Medicine2014 Rural Health Services Research Conference Registration
  • Home

    RHSR Conference Registration

    Step 1 of 4

    25%
    • This field is for validation purposes and should be left unchanged.
      Please list any allergies under "other."
      Please note that valid student ID will be requested at registration.
    • $ 0.00 CAD
    • Please verify that the information below is correct: Name: [display_input name="input_1"]
      Title: [display_input name="input_2"]
      Institution / Organization: [display_input name="input_3"]
      Secondary Title: [display_input name="input_4" else_display="not provided"]
      Secondary Institution: [display_input name="input_5" else_display="not provided"]
      I would like my name, title , and institution/organization listed in the conference program as a participant: [display_input name="input_13"]

      Address:
      [display_input name="input_6_1" else_display="No steet address provided"]
      [display_input name="input_6_2"]
      [display_input name="input_6_3"]   [display_input name="input_6_4"]

      Email: [display_input name="input_7"]

      I will be attending:
      Thursday Program: [display_input name="input_10.1"]
      Thursday Movie Night: [display_input name="input_10.2"]
      Firday Program: [display_input name="input_10.3"]
      Fiday Pechakucha Night: [display_input name="input_10.4"]

      Walk with a presenter: [display_input name="input_11"]
      to discuss:
      [display_input name="input_12_1"]
      [display_input name="input_12_2"]
      [display_input name="input_12_3"]
      [display_input name="input_12_4"]
      [display_input name="input_12_5"]

      Diet: [display_input name="input_14"]
      Student: [display_input name="input_8"]
    • $ 0.00 CAD

    Rural Health Services Research Network of BC
    Faculty of Medicine
    Room 300, David Strangway Building
    5950 University Blvd.
    Vancouver, BC Canada V6T 1Z3
    Tel 604 827 2194
    Website www.rhsrnbc.ca
    Email email.email@ubc.ca
    Back to top
    The University of British Columbia
    • Emergency Procedures |
    • Terms of Use |
    • Copyright |
    • Accessibility