Registration form

	* Gender:
	Mrs.  Mr.
First name		*
Name		*
Organism
Address		*
Town		*
Postal Code		*
Phone		*
Fax
E-mail		*
	* Level:
	Public at large ¹ Official representative from a private or public organization ² Representative from the community and volunteer sector
	¹ citoyen, patient atteint de cancer, proche, individu
	² institution publique, entreprise, syndicat, association professionnelle, industrie pharmaceutique ou de tout autre organisme issu du monde des affaires
	* Days
	Day 1 - May 14 Day 2 - May 15 Day 1 and 2 - May 14 and 15
	* Do you need our assistance? Upon receipt of your registration form, we will contact you to confirm your admissibility to reimbursement. After confirmation, arrangements will be made for lodging and/or transportation.Policy on the Assistance to Participants)
	Yes  No
Comments
	* Fields marked with a star are mandatory.