Canadian Epilepsy Research Initiative

 

 

 

 

 

 

 

 
Registration for CLAE-CERI Retreat, September 23 – 25, 2005
Personal Information
First Name
Middle Initials
Last Name
Institution
Division
Department
Email
Telephone
Address
Street
City
Province / State
Postal Code / Zip Code
Country
I Plan to Attend the CLAE-CERI Retreat
Including (Check all that apply)
Reception, Dinner (September 23, 2005)

Evening Session (September 23, 2005)
Sessions AM (September 24, 2005)
Sessions PM (September 24, 2005)
Sessions AM (September 25, 2005

My professional domain is best described as: (Check all that apply)
Basic research
Clinical research
Clinical practice
Allied health research
Allied health practice
Other:
I plan to submit an abstract for the poster presentation
Check for Yes

I am /wish to be a member of the following Team(s) (Check all that apply)
Brain Development & Epilepsy
Consciousness & Epilepsy
Dual Diagnosis / Co-morbidity
Fits and Fitness to Drive
Health Care Delivery - Aboriginal Health
Initiation, Spread, Synchronization of Epilepsy
Intractable Epilepsy
Knowledge Translation in Epilepsy
Longitudinal Studies
New Targets & Therapies
Neurogenetics & Epilepsy
Temporal Lobe Epilepsy
Other
(Seperate by ;)
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