Brenda Milner Centennial Symposium
Montreal Neurological Institute
3801 University Street
Montreal, Quebec

September 6-7, 2018

Regretfully we have reached our capacity for attendance at the Brenda Milner Centennial Symposium. If you wish to be placed on our waiting list, please fill in this form. Should a space open up, you will be notified. Thank you.

* Family Name:
* Given Name:
* Title:
* Affiliation:
* Email:
* Telephone:
Fax:
* Address:
* City:
* Postal / Zip Code:
* Province / State / Territory:
* Country:
* I will be attending:
Dietary Restrictions:
Additional Information:
* I will be submitting an abstract:
Abstract Authors:
Abstract Affiliations:
Abstract Title:
Abstract (PDF only, max file size 6mb):

For security reasons, please enter the characters in the image into the text box
If you are on a laptop computer, please follow this link to
retrieve a fresh code immediately before submitting your form