ON LINE REGISTRATION FORM FOR CARIBBEAN NEUROSURGERY CONFERENCE

Embassy Suites Hotel and Casino, San Juan, Puerto Rico- - November 6 - 9, 2019

Complete all the data fields then click on the submit button. All fields marked with an asterisk are required.

First Name *

Last Name *

Your email *

Re-enter email *

Your Occupation - select one Neurosurgeon Neurologist Internist Radiation Oncologist Neuroendovascular Surgeon Orthopedic Surgeon Resident Nurse Company Representative

Office phone ( include area code)

Cell phone (include area code)

Your postal address 1

Your postal address 2

City

County or State

Country

Date Form Completed

I wish to register for the CANS 44th Annual Neurosurgery Conference November 6 - 9, 2017

Yes, I wish to register for the conference

No, I do not wish to register.

I will be attending the Welcome Reception on Wednesday 6 November 2019. If "yes" state the name of your guest here

Yes, I will be attending the Welcome Reception

No, I will not be attending the welcome reception

I will be attending the Formal Awards Banquet on Friday 8 November 2019. If "yes" state the name of your guest here

Yes, I will be attending

No, I will not be attending

I wish to submit a scientific paper for consideration of inclusion in the scientific program.

Yes, I wish to submit a scientific paper.

No, I will not be presenting a paper

If you wish to submit a scientific paper for consideration of inclusion in the scientific program please submit the title, the name of the presenting author, and a brief summary of less than 200 words in the larger text box below.

This box is reserved for scientific abstracts only. The final date for abstract submission is 15 October 2019.

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