Principles of Oncology
Online Registration Form
 

If your employer is paying for the course and cannot pay with a credit/debit card, check the appropriate block at the bottom of the form.  Full payment must be received within 21 days of registration or 30 days prior to the start date (whichever comes first) to ensure your class seat is not lost. 

*Denotes required items

Date/Location of Course*               

Name*  
Facility*   (hospital, company, or "none")
Address*
 		  
 
City*       State/Province*       Zip*    
Daytime Phone*   -   -    ext
Home Phone   -   -    (for use in case of weather-related or other emergency)
FAX Number

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E-mail address*  

  Check here if you will bringing a laptop with electronic reference materials for classroom use.

Note any dietary restrictions (vegetarian, kosher, etc):   

How many years have you been a registrar?*          


   Check here if payment will be sent by by the facility indicated above.
         (When you get to the online payment page, just close your browser.)

Please be sure all information is correct before proceeding to credit card payment