PMCQ |Meeting Reservation Form

P.M.C.Q. Online Meeting Reservation Form

After completing the order form below, you will be taken to the Moneris secure payment website by clicking on the button Proceed to checkout, where you can pay by a major credit card of your choice. You will receive a receipt by email to the address you specify in the email field below shortly thereafter. Please note that your personalized name tag(s) and ticket(s) will be prepared according to the information entered on the form and will be available at the registration desk the day of the event.

Fields marked with an * are mandatory

Meeting Date*

First Name*		Last Name*
Company*		Address*
City*		Postal Code*
Province*		Telephone*
Fax		E-mail*

Attendees
Attendee Name*	Attendee Company	Member: Non-Member:	Employees of the following companies are entitled to register at Member rates: Bristol Myers Squibb Lundbeck Merck Novartis Pfizer Sanofi Aventis Schering Shire
		$ .00
		$ .00
		$ .00
		$ .00