Registration Form – McMaster Muskoka Seminars

Cheque Payments: Print and fill out this Registration Form and mail it to the address below along with your cheque made out to McMaster University

Don't forget to arrange your accommodations directly with Deerhurst Resort

Course Tuition and Materials: Regular Rate $645.00 per course; Student Rate $345.00 per course

Early Bird Rate $595 - registration and payment MUST be received by June 30, 2011

Name: __________________________________________________________________________________________________  

Profession:  ______________________________________________________________________________________________

Address:_________________________________________________________________________________________________

Facility: __________________________________________________________________________________________________       

Email:___________________________________________________________________________________________________

Phone: __________________________________________________________________________________________________     

Fax: ____________________________________________________________________________________________________  

Credit Card Number:_______________________________________________________________________________________

Expiry:__________________________________________________________________________________________________

 Course Registration – Please check off desired course(s) – one course only per week:

__    July 25-29: CBT for Weight Management

__     July 25-29: GP Psychotherapy

__    August 1-5: Psychiatry for Family Physicians

__    August 1-5: Mindfulness I

__    August 1-5: Law & Psychiatry

__    August 8-12: Mindfulness II

CHEQUE PAYMENTS – Please make cheques payable to “ McMaster University ”

 MAIL to : Suzy Konick, McMaster Muskoka Seminars, St. Joseph ’s Healthcare, Hamilton , West 5^th Campus, P.O. Box 585 , Hamilton , ON , L8N 3K7

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