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.

Montreal QC, McGill University

December 3, 2010

Application Deadline: November 19, 2010

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.

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