Canadian Epilepsy Research Initiative

 

 

 

 

 

 

 

 

Registration for CLAE-CERI Retreat, September 23-25, 2005

 


Personal Information

 

 
First Name
Middle Initials
Last Name
Inistitution
Division
Submit Abstract
  Y - Yes
  N - No
Department
Email
Telephone
Address
City
Province / State
Postal Code
Country

 
Please note: You may return to previous sections of the form by clicking on the tabs and complete the empty fields. Resubmitting does not erase already entered information." />

 

 

 

 

 
© - Canadian Epilepsy Research Initiative