TEACHING & LEARNING ABOUT DIVERSITY & EQUITY

Completion of the following registration form will confirm your seat at the conference "Teaching & Learning About Diversity & Equity" for Ontario Midwifery Clinical Preceptors hosted by the Ryserson University Midwifery Educational Program.

The conference will be held Monday, February 10th, 2014 from 8:30am - 4:30pm at the Cara Commons located in the Ted Rogers School of Management (55 Dundas St. W., Rm. 1-148 on the 7th floor.)

Travel subsidies are available for those interested.

For more information or if you have any questions please contact Joanna Galasso @ jgalasso@ryerson.ca

Looking forward to seeing you at the conference!

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* 1. First Name

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* 2. Last Name

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* 3. E-mail Address: please provide the address at which we are most likely to reach you (confirmation of registration and other conference information will be sent to the email address provided)

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* 4. Midwifery Practice: please include the practice name, practice mailing address and practice phone number

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* 5. Breakfast, lunch & snacks will be provided: please indicate any dietary restrictions you may have

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* 6. Accessibility Needs (if applicable): Please provide us with any accessibility needs you may require

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* 7. I am interested in receiving a travel subsidy

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* 8. If applicable, the distance I will travel to the conference is (one way, in kilometres)

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* 9. Method of transportation to the conference

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