CME & CULTURAL & GASTRONOMICAL TOUR OF SPAIN

SEPTEMBER 25 - OCTOBER 7, 2023

PRE - REGISTRATION FORM

NO DEPOSIT REQUIRED !

GROUP MEDICAL DIRECTOR:
DR. RACHEL KASSNER, CHARLOTTETOWN, P.E.I.

Registrant Information

Title *

First Name *

Surname *

Number of registrants in your party: *

Number of rooms required: *

Single room

Double room

Triple room

Contact Information

Street Address *

Address Line 2

City *

Province/State/Region *

Zip/Postal Code *

Country *

Phone No. (home/cell) *

Phone No. (business)

Fax No.

Email Address *

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Click the optional button below to print a copy of your form for personal records. You must still click the Submit button below to complete your pre-registration.