FINAL2016 Critical Care Registration (PDF)

5Th Annual Edmonton Critical Care Symposium
SEPTEMBER 21, 2016
LISTER CENTRE
11613 87 Ave NW
Edmonton, AB

0800H - 1600H
Doors open at 0715H

FEE: $75
Max. Number of Attendants: 250

Lunch and refreshments provided.
Please bring your own coffee travel
mugs to reduce waste.
LOTS OF DOOR PRIZES! NEW CLOTHING AND
SWAG @ the ECCS BOUTIQUE! (CASH ONLY)

REGISTRATION FORM:
(PRINT CLEARLY)
* Mandatory
1. First Name*: ____________________________________

INCLUDING TALKS:
 From the ER to ICU by
Dr. Dennis Djogovic
 Antibiotic Stewardship by
Dr. Wendy Sligl
 PTSD and Nursing Burnout
 The ABC’s of CVICU by
Dr. Gurmeet Singh
 Legal Issues
 Street Drugs by Officer Brad, RCMP
 …and much more!
See you there!
LIKE US ON FACEBOOK:
Edmonton Critical Care Symposium

2. Last Name*: ____________________________________
3. Professional Designation*: ________________________
4. Phone Number*: (_____) _________-________________
5. Work Email*: _____________________________________
________________________________________________
________________________________________________
6. Personal Email*: ___________________________________
_______________________________________________
_______________________________________________
7. Dietary Restrictions: ______________________________
Cut and mail this portion of form along with a
cheque or money order (NO CASH!) to:
Box #2096, 61 Broadway Boulevard,
Sherwood Park, AB, T6H 2C1
E-Transfers also accepted! Send $75 to yegccs@gmail.com.
Please enclose above #1-7 in body of email to
yegccs@gmail.com, and please include e-transfer question and
password to access fee amount! Thank you!