* 1. First Name

* 2. Last Name

* 3. E-mail Address

* 4. Institution / Organization / Company

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

* 6. Professional Role / Title and Department if applicable

* 7. Will you be attending the light lunch (12:45 pm to 1:30 pm) following Dr. Alan Bernstein's Lecture at U Ottawa on Tuesday, October 31, 2017?

* 8. Have you attended previous Friesen Prize Program events?

* 9. Will you review the FCIHR web site:  www.fcihr.ca  ?

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