SGM 2015 Registration - Apr 23rd-26th - Vancouver BC

Each individual attending CFMS SGM 2015 must complete this form in its entirety. *Those applying for travel funding - please do not register until after results have been announced.

REGISTRATION FEES: Registration fee is $130 per delegate, payable by cash or cheque to CFMS or in person at SGM 2015. This DOES NOT include hotel accommodations. Students must arrange for their own hotels (excluding CFMS-funded delegates).

*NEW*: This year, all SGM 2015 attendees MUST register for CCME and will be required to pay a $50 student fee. You will be directed to their registration at the end of this form.

CONFIRMATION OF REGISTRATION: Attendees will NOT receive a confirmatory email, as it is not possible using this platform. Please be assured that once you click "Done" your registration is confirmed.

Please contact office@cfms.org and/or vpcommunications@cfms.org with any questions.

**PLEASE NOTE: By clicking "Done" you are agreeing to pay the registration fee. Failure to pay registration fees after confirming registration may result in a letter being sent to the appropriate faculty of medicine.

Question Title

Please fill out the form bellow for EACH INDIVIDUAL participating in CFMS AGM 2014 (this should include each MedSoc President, CFMS Representative, PAC Rep, Global Health Liaison, Guest or General Student Member who wishes to participate).

Name: *

School/Organization: *

Email Address: *

Phone Number:

Question Title

GENDER
(Please note: The CFMS recognizes that gender is a spectrum and SGM 2015 is gender sensitive and inclusive environment. We ask your gender for rooming purposes only. Delegates funded through the CFMS are placed in single-gender rooms at quadruple occupancy. If you have a specific concern related to this, please indicate at Question #8.)

Male

Female

Other (please specify)

Question Title

In what capacity are you attending the CFMS SGM 2015?

CFMS Executive Member

CFMS Representative (Senior)

CFMS Representative (Junior)

CFMS Representative to an External Organization (please indicate below)

Med Soc President

Global Health National Officer

Global Health Liaison

Global Health delegate - other (please indicate below)

General Student Member

National Officer (other than Global Health - please indicate below)

Government Affairs Committee Rep

CFMS Travel Funding Recipient

Invited Guest/Observer (please indicate your affiliation below)

Please describe here

Question Title

Is this your first time attending a CFMS General Meeting?

Yes! This is my first CFMS General Meeting

No, I'm a returning delegate since I've attended at least one previous AGM or SGM

Unknown at this time

Other (please specify)

Question Title

Will you be attending the Global Health Program portion of SGM 2015?

Yes

Question Title

Do you anticipate that you will be attending the following CFMS Social Events at SGM 2015?

	Yes	No
Friday Evening Dinner - April 24th, 2015	Friday Evening Dinner - April 24th, 2015 Yes	Friday Evening Dinner - April 24th, 2015 No
Friday Night Social - April 24th, 2015	Friday Night Social - April 24th, 2015 Yes	Friday Night Social - April 24th, 2015 No
Saturday Night Social - April 25th, 2015	Saturday Night Social - April 25th, 2015 Yes	Saturday Night Social - April 25th, 2015 No

Question Title

Please indicate any food restrictions/preferences:

None

Vegetarian

Vegan

Other (please specify)

Question Title

Do you have any special needs or require special assistance?

Yes (please describe below)

Description: