Registration Form - 2023 McGill Department of Medicine Annual Research Symposium - December 12, 2023

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* 1. Family Name

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* 2. First Name

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* 3. Profession

MD

PhD Scientist

Resident / Student

Other

Other (please specify)

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* 4. CMQ License # (required for MDs only)

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* 5. Division

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* 6. Site

MUHC / RI MUHC

JGH / LDI

SMH

Other (please specify)

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* 7. Email Address

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* 8. Will you be attending in-person or by Zoom?

In-person (RI Auditorium - E S1.1129)

Zoom (link will be emailed to you)