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Registration Form

2009 McMaster Muskoka Seminars

Registration Cost: $645 each course

Course Registration – Please check off desired course (s) - note only 1 course per week:

q       WEEK 1A –  Evidence-Based Mental Health                                                 July 13 – 17, 2009                 Blue Mountain Resort

q       WEEK 1B –  Mindfulness – Practical Approaches                                        July 13 – 17, 2009                 Deerhurst Resort

q       WEEK 2A –  Moods & Cycles                                                                          July 20 – 24, 2009                 Blue Mountain Resort

q       WEEK 3A P.M. –  Psychiatry for Family Physicians                                      July 27-31, 2009                    Deerhurst Resort  

q       WEEK 4A P.M. –  Practical Intro to General Practice  Psychotherapy       August 10 – 14, 2009           Blue Mountain Resort 

q       WEEK 5A –  Promoting Resilience and Preventing Burnout                       August 17 – 21, 2009           Deerhurst Resort 

q       WEEK 5B -  A New Continuum Approach to Resolving Depression         August 17 – 21, 2009           Deerhurst Resort

Name:_________________________________________________________________________________

Facility: _______________________________________________________________________________

Address:_______________________________________________________________________________

City:__________________________________________________________________________________

Province:______________________________________________________________________________

Postal Code:____________________________________________________________________________

Telephone:_____________________________________________________________________________

Fax:__________________________________________________________________________________

E-mail:________________________________________________________________________________

Profession/Occupation:____________________________________________________________________

Payment by:   ___ Cheque       (payable to McMaster University)   or Credit Card:  ____ Visa        ____ MasterCard  

I authorize McMaster University to bill the account below in the amount of $_________________:

Card #___________________________________________       Name on Card: ____________________________________

Expiry Date:__________   Cardholder Signature:_________________________________

PLEASE DO NOT EMAIL CREDIT CARD NUMBERS OR PERSONAL INFORMATION

Please fax form to 905-381-5606 (fax machine is in a secure area)  or mail to Carin Kelley, McMaster Muskoka Seminars, Room F212, 100 West 5th Street, P.O. Box 585, Hamilton, Ontario, L8N 3K7 

Make cheques payable to McMaster University. Telephone Inquiries 905-522-1155 ext.36493

Please contact the resort directly to make arrangements for accommodations of your choice.