Department of Obstetrics & Gynaecology
11th Annual Paul Harding Research Awards Day

May 1, 2013

This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by Continuing Professional Development, Schulich School of Medicine & Dentistry, Western University (7.5 hours)

(NOTE THAT IN THE FORM BELOW AN ASTERISK INDICATES A REQUIRED FIELD)

Name*
Email*
	Yes! I'm attending Research Day
	Yes! I'll attend Lunch
	Yes! I'll attend Dinner
My Dinner Choice:	Beef Chicken Salmon
Guest Name:
My Guest's Dinner Choice:	Beef Chicken Salmon
Dietary Restrictions: (Please indicate whether this refers to yourself or your guest)