ONIG September 20th Education Day - WOHS
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1. ONIG Education Day
LOCATION:
William Olser Health System
2100 Bovaird Drive East
Brampton, ON L6R 3J7
DATE:
Monday September 20, 2010
*
1
. First Name:
First Name:
*
2
. Last Name:
Last Name:
3
. Title and Credentials:
Title and Credentials:
4
. Organization/Place of Employment:
Organization/Place of Employment:
5
. Are you an ONIG member?
Are you an ONIG member?
Yes
No
Don't know
*
6
. Will you be attending the Education Day...
Will you be attending the Education Day...
In Person
In Person as an Executive Guest
Via Videoconference
Via Webcast
If guest, enter ONIG Executive Name
*
7
. Email address:
Email address:
8
. Dietary/Allergy Restrictions?
Dietary/Allergy Restrictions?
No
Vegetarian
No Pork
Other dietary restrictions or allergies
Specify:
9
. How did you hear about the meeting?
How did you hear about the meeting?
ONIG distribution or event
RNAO distribution or event
CNIA distribution or event
Word of mouth
Email forward
ONIG Website
Other (please specify)
10
. Network Information (select all that apply)
Network Information (select all that apply)
I agree to share my name and demographic information
I agree ONIG may take and use my picture for ONIG related purposes (e.g. newsletter or website)
Do not publish my network information
I do not agree to the use of my picture and I will advise ONIG at registration. If attending in person I realize that the event is broadcast via videoconference and webcast and I may be included as an audience member.
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