2010 Friesen Prize Registration
Exit this survey

1. 2010 Henry G. Friesen International Prize in Health Research

Registration for the Public Forum featuring
Dr. Shirley M. Tilghman, President of Princeton University.

"Science and Enterprise as a Social Good: the Role of Universities"

Date: September 29, 2010
Venue: University of Ottawa, Tabaret Hall, 550 Cumberland St.
Time: 1:15 - 3:00 pm

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1. First Name

First Name

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2. Middle Name (if any)

Middle Name (if any)

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3. Last Name

Last Name

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4. E-mail Address

E-mail Address

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5. Mailing Address

Mailing Address

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6. Phone Number (office)

Phone Number (office)

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7. Phone Number (Other)

Phone Number (Other)

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8. Institution/Organization/Company

Institution/Organization/Company

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9. Type of Institution/Organization/Company (Choose all that apply)

Type of Institution/Organization/Company (Choose all that apply) University/College/Academic Institution

Hospital

Industry

Government

Non-profit Agency

Media

Other (please specify)

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10. Professional Role/Title and Department if applicable

Professional Role/Title and Department if applicable

2010 Friesen Prize RegistrationExit this survey

1. 2010 Henry G. Friesen International Prize in Health Research

*1. First Name

*2. Middle Name (if any)

*3. Last Name

*4. E-mail Address

*5. Mailing Address

*6. Phone Number (office)

*7. Phone Number (Other)

*8. Institution/Organization/Company

*9. Type of Institution/Organization/Company (Choose all that apply)

*10. Professional Role/Title and Department if applicable