2017 Retreat

Neural circuits: from molecules to disorders to health care

October 27-29, 2017

Registration Form

Please note: Attendance is by invitation only.

* Items with an asterisk must be filled in.
* Family Name:
* Given Name:
* Title:
* Department:
* Email:
* Telephone: (please supply most accessible phone number)

Family Info

I will be bringing:

* please select all that applies

    October 27, 2017

    October 28, 2017

    October 29, 2017


* please select all that applies
        Age:

    October 27, 2017

    October 28, 2017

    October 29, 2017


* please select all that applies
        Age:

    October 27, 2017

    October 28, 2017

    October 29, 2017


* please select all that applies
        Age:

    October 27, 2017

    October 28, 2017

    October 29, 2017


* please select all that applies
        Age:

    October 27, 2017

    October 28, 2017

    October 29, 2017


* please select all that applies
        Age:

    October 27, 2017

    October 28, 2017

    October 29, 2017


* please select all that applies
        Age:

    October 27, 2017

    October 28, 2017

    October 29, 2017


* please select all that applies
        Age:

    October 27, 2017

    October 28, 2017

    October 29, 2017

Total: $ 0.00
Make check payable to the Montreal Neurological Institute & Hospital
Memo line: 2017 Retreat
Submit to Debbie Rashcovsky, 3801 University Street, room 636

Attendee Info

* please select all items where you will be present

Accommodations

October 27, 2017

October 28, 2017

October 29, 2017

Dietary concerns:
Additional Comments:

Carpooling

  • - I have room for persons

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