Trillium Research Day  - Primary Health Care Research Day

 

REGISTRATION


Primary Health Care Research Day- Trillium 2018
Sheraton Centre Hotel, 123 Queen Street West
Mezzanine Level - Willow Room
Toronto
Wednesday, June 6th, 2018


Registration DEADLINE: Friday, May 18, 2018

Payment deadline: May 25, 2018 (Friday) Please note: We recognize that payment by cheque may be delayed past the Registration deadline of May 18, 2018. We will follow up if payment is not received by
May 25th 2018.

REGISTRANT INFORMATION:
Title:
Surname:
First Name:
Status:

Researcher
Clinician
Administrator
Graduate Student Resident
      (For presenting Graduate Students/ Residents: Limited travel
       grants available based on geographical representation.
       If lead and co-presenter are both presenting they will share one travel grant.)
Patient / Community Member
       (Limited travel grants based on geographical representation)
Other, please specify  

Institution/Affiliation/Company:
Department:
Address:
City:
Province:
Postal Code:
Phone:
Fax:
Email: (mandatory)
Alternate Contact Name:
Alternate Contact Email:
Alternate Contact Phone #:
   
CONFERENCE DETAILS:
Main Discipline:
Please specify discipline:
Please select a Workshop: ( 2:40 pm - 4:00 pm )
Workshop 1: Patient and Family Storytelling in Primary Health Care Research
Lisa Hawthornthwaite, Fellow with the AMS Phoenix Project; Lauren Lee, patient facilitator; and Mim O'Dowda, patient facilitator.
The workshop will help research partners understand and prepare for the important role of supporting patients who are sharing stories in the process of a research project. If you are using patient stories in your research, this workshop will discuss the necessary role of facilitator to help ensure stories are being used for a productive research discussion... <read more>
Workshop 2:  Integrating Rigorous Evaluation into Learning Health Systems in Ontario
Dr. Merrick Zwarenstein, Director of Research, Centre for Studies in Family Medicine, Western University and Dr. Jen Rayner, Epidemiologist and Lead of Research Program, Association of Ontario Health Centres (AOHC)
Undecided
Did you submit an abstract?
Yes, I have already submitted an abstract.
I will be sending in my abstract.
No I am NOT submitting an abstract
Undecided
   

Please advise if you have any food allergies:

REGISTRATION FEES:


Registration Fee:
Please select appropriate fee:

  Presenting Non-Presenting
Attendee $84.75 $101.70
Resident/Student Free if Presenting
 ** Limited travel grants are available
$56.50
Patient
/ Community Member
Free if Presenting
 ** Limited travel grants are available
$56.50
** Please note: Limited travel grants will be made available by geographical regions for presenting student, resident, patient and community members.  If co-presenting the grant will be shared with your co-presenter.  If selected you will be notified by email.

I will pay registration costs by:
Cheque (payable to "The University of Western Ontario")
On-line Credit Card Payment (Visa or Master Card) -- secure link at Western.
       
 (If you choose on-line Credit Card, on next screen you wil be asked for the credit card details.)

Verification Submission Code:
Please enter the text you see in the image. Make sure you enter it exactly as you see it(upper and lower case). This is required to prevent us from getting spam submissions. Then press the Submit button to send your form. Thank you.