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MRC 2019 - Contact Information

Your Title*

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Dr.

Mr.

Mrs.

Ms.

First Name*

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Surname*

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Mailing Address*

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Home Phone Number

Mobile Phone Number

E-mail Address*

Kindly indicate your salutation*

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Student Price

Students (with valid ID) pay $300 (per day)

Your Speciality

How many persons are registering?*

One (1)

Group of 2 - 9

Group of 10+

Names of Persons*

Accomodations / Dietary Needs (if applicable) *

I have a disability and may need special accommodations to fully participate.

Vegetarian

Other dietary restrictions

No Restrictions

Please contact a member of conference staff (listed below) that can assist with your needs:

The T&TMA HQ #1, 6th Street, Xavier St. Extension, Chaguanas. Trinidad 671-7378
Librarian Port of Spain General Hospital Library 623-2437
Dr. Boysie Mahabir Level 3, Long Circular Mall, St. James 622-0000
Dr. Solaiman Juman Campus House, Eastern Main Road, St. Augustine 645-2368
Dr. Maria Dillon-Remy 151 Calderhall Road, Scarborough, Tobago 635-0839
Librarian San Fernando General Hospital Library 652-5215
Dr. Edmund Chamely 5 Queen Street, King’s Wharf, San Fernando 652-3555

Other dietary restrictions

Please state what they are.

How would you like to receive your AACME Certificate?*

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T&T Medical Association

25th Annual Medical Research Conference

MRC 2019 - Contact Information

Student Price

Please contact a member of conference staff (listed below) that can assist with your needs:

Your form has been submitted

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