June 5 - 7, 2019

Old Mill Toronto
Toronto, Ontario


Online Registration


Section A - Delegate Information

If you experience any technical difficulties when using this form or if you have registration questions, please contact Canadian Critical Care Review Program at: info@criticalcarereview.ca

 

Email Address:
Title:
First Name:
Last Name:
Program Director:
Department:
Institution:
Address Line 1:
Address Line 2:
City/Town/Village:
State/Province: (Canada or U.S.A only)

- If "Other" then please specify -

Zip/Postal Code:
Country:
Business Number: Ext:
Home/Cell Number:
Fax Number:
   
Please indicate if you have any dietary restrictions, requirements or allergies:
   
Special Needs:
   
Additional Comments:

I have completed or will be completing my training in 2018: Yes  No

How did you hear about this conference?





 


 

Section B – Delegate Registration

Registration fees include: admission and online meeting archive recording for all sessions, breakfasts, lunches and nutrition breaks indicated in the program.

Space is limited. Register early to ensure your place in the workshop.

Attendee

(All fees quoted in Canadian dollars)

Registration Fee Paid

on or before April 12, 2019

Registration Fee Paid

April 13, 2019 and later


Residents, Fellows and International Medical Graduates in a Canadian program

Workshop* (June 5, 2019)

Conference (June 6 - 7, 2019)

$400
($452.00 after tax)

$565
($638.45 after tax)

$400
($452.00 after tax)

$665
($751.45 after tax)

*Workshop can be purchased in addition to conference registration or on its own.


Allied Health Care Professionals

Workshop* (June 5, 2019)

Conference (June 6 - 7, 2019)

$500
($565.00 after tax)

$565
($638.45 after tax)

$500
($565.00 after tax)

$665
($751.45 after tax)

*Workshop can be purchased in addition to conference registration or on its own.


Physicians who are members of the

Canadian Critical Care Society

Workshop* (June 5, 2019)

Conference (June 6 - 7, 2019)

$500
($565.00 after tax)

$800
($904.00 after tax)

$500
($565.00 after tax)

$900
($1,017.00 after tax)

*Workshop can be purchased in addition to conference registration or on its own.


Physicians who are NOT members of the Canadian Critical Care Society

Workshop* (June 5, 2019)

Conference (June 6 - 7, 2019)

$500
($565.00 after tax)

$1,000
($1,130.00 after tax)

$500
($565.00 after tax)

$1,100
($1,243.00 after tax)

*Workshop can be purchased in addition to conference registration or on its own.

 

Hotel Accommodation and Travel Arrangements
A group room rate of $210 CAD per room (single/double occupancy) per night (plus applicable taxes) is being offered to participants. Rooms at the conference rate are available until the reserved block of rooms is filled or April 30, 2018, whichever occurs first. It is therefore recommended that participants requiring accommodations book as soon as possible. You must indicate that you are with the Canadian Critical Care Review Program to receive the group rate.

Reservations made by individuals will require a valid credit card at the time of booking. A non-refundable deposit in the amount of one night's room charge plus HST will be charged to the credit card on file three days prior to the arrival date.

 

Please contact the hotel directly at:

Old Mill Toronto
21 Old Mill Road
Toronto, Ontario
M8X 1G5
Canada

Local: 416-236-2641
Toll Free: 1-866-653-6455

www.oldmilltoronto.com

 


 

Section C – Payment Information

Please verify all the information is correct. By submitting your payment your credit card statement will show this transaction as Canadian Critical Care Review Program.

 

Cancellation Policy
All cancellations must be received in writing no later than May 15, 2018 for a full refund, less an administrative fee of $100.00. No refunds will be issued after this date.

 

I acknowledge that I have read and accept the conditions of this policy

 


 

Section D - Participant Consent & Release Agreement

(Please scroll to the end and click on I AGREE after reading.)

 

CONSENT TO BE VIDEO RECORDED, AUDIO RECORDED, PHOTOGRAPHED, RECORDED AND/OR TO HAVE PUBLIC DISCLOSURE OF INFORMATION, AND WAIVER OF CONFIDENTIALITY FOR MEDIA PURPOSES.

I hereby give my permission and express written consent to Canadian Critical Care Review (CCCR) to digitally video record, videotape, digitally audio record and/or photograph me while I am attending and participating in the CCCR. I further consent to CCCR and its agents and assigns exhibiting, showing, re-producing, publishing, displaying, transmitting and other uses of all such video and audio recordings and photographic images in any media whatsoever in Canada or elsewhere, including presentations made for medical, scientific, educational and related marketing purposes.

I further acknowledge, confirm and agree that I shall have no right to inspect or approve any video and audio recordings and/or photograph(s) of me prior to it or their use by CCCR or its agents and assigns in any manner and confirm and agree that I will receive no financial compensation arising from such use, including, without limitation, my providing services as a model.

I hereby fully and finally release CCCR and its agents and assigns from any and all liability directly or indirectly arising out of the video and audio recordings and photographic images made and/or taken of me including, without limitation, how such recordings and images are used by CCCR and its agents and assigns, the final form of such recordings and photographs and the timing, method and basis of it or their publication and distribution.

I acknowledge that CCCR and its agents and assigns shall have the right to cancel any event offered or organized by CCCR or its agents and assigns for which I may register to attend up to and including the day immediately prior to the scheduled commencement date of such event by email notification to me at the last email address I have electronically delivered to CCCR. I hereby further release CCCR and its agents and assigns from any and all claims relating directly or indirectly to such cancellation that I or my heirs, executors and administrators may have and hereby confirm and agree that CCCR and its agents and assigns shall at no time be liable to me or my heirs, executors and administrators for any direct or consequential losses, damages, expenses or costs which I may suffer or incur as a result of a cancellation, including, without limitation, unnecessary travel expenses and loss of income.

WAIVER OF LIABILITY AND ASSUMPTION OF RISK ACKNOWLEDGEMENT.

In consideration of CCCR permitting me to participate in any capacity whatsoever in the CCCR (including but not limited to participation as an attendee or speaker), I hereby agree to the following terms:

  1. I expressly warrant and represent that by attending the CCCR I am knowingly, freely and irrevocably assuming all risk while participating in and or attending the CCCR, in any manner whatsoever, regardless of how, where or when I may incur or sustain any injury, damage or loss, and whether or not resulting from the negligence of CCCR or otherwise.
  2. None of CCCR or its directors, officers, employees, agents or consultants (the “Releasees”) shall be liable nor held responsible in law by me, or my heirs, executors, assigns and any legal or personal representatives for any physical bodily injury (including loss of life or limb), damage or other loss (including but not limited to economic loss) incurred by me, however sustained or incurred at any time during my participation or attendance at the CCCR, including my travel time to and from the CCCR.
  3. I hereby irrevocably release and hold the Releasees harmless in respect of any and all liability for and in respect of my physical injuries and/or economic loss derived from my participation and involvement, in any manner, in the CCCR.
  4. Once I have agreed to this Participant Consent and Release Agreement, it will constitute a full answer and defence in favour of the Releasees in relation to any claim that I may advance against same for any physical injury, damage or loss sustained by me while participating in or attending the CCCR.
  5. I understand that it is a condition of my participation in the CCCR that I must agree to the terms of this Participant Consent & Release Agreement and that I am under no requirement or compulsion to participate or attend the CCCR and I am free to decline participation if these terms are not acceptable to me.
  6. While attending the CCCR I agree to abide by all rules posted or otherwise provided to me, as well as all applicable federal, provincial and municipal laws and regulations.
  7. I agree that regardless of actual causation, I am solely responsible for my safety while participating and attending the CCCR.

I have read the foregoing Participant Consent & Release Agreement and confirm and agree that I fully understand its contents. I hereby warrant that I am of legal age and am competent to contract. I hereby provide and deliver both my express and informed consent as stated above and my agreement with the terms as outlined above by clicking on the I AGREE button as presented on this website and confirm that this Participant Consent & Release Agreement when given in this manner shall be forever binding upon me.

 

I agree to consent to have my name, address and email added to the mailing database for upcoming conferences: Yes    No

 


 

Press Submit to complete your registration.

 

 

If you have already registered but have not yet paid you can pay your registration fee here.

If you experience any technical difficulties when using this form or if you have registration questions, please contact Canadian Critical Care Review Program at: adm@criticalcarereview.ca

 

Registration
Audio Sessions
Canadian Critical Care Society
Critical Care Forum


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