Complete all fields below and submit.  Our system will advise us when your school has registered.  Your online registration will generate a link to our site which will be unique to your school and this event.  Students will need this link to register themselves online.  The link will be emailed to you with further details within the next few days.  If you do not receive an email within 5 business days, please call The Canadian Medical Hall of Fame at 519-488-2003.

Waterloo ON, University of Waterloo

April 21, 2010

Application Deadline: April 15, 2010

Each school is invited to register students who have a strong interest in health sciences. The first step is to register your school online. Once your school is registered, you will receive an email with further instructions to register your students.

School Name: *

City: *

School Board: *

Telephone: *

Fax:

School Contact Person First Name: *

School Contact Person Last Name: *

Email Address: *

Name of Teacher Registering for Event:

Agreement: *

I Agree to the following terms and conditions.

I will fax or email a signed "Informed Consent and Waiver of Liability" form for each student to the CMHF in advance of the event.

Thank you for your interest in our Discovery Day program!

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