SMARTRISK Learning Series Registration

SMARTRISK Learning Series

Online Registration Form

Please fill in all the fields.

First name:
Last name:
Title:
Organization:
Type of organization:
City:
Province:
Region: If in Ontario, what region are you in?
Country (if not Canada):
Email Address:
Telephone Number:
Audience Size: How many people will be listening to the teleconference at your location?

Please check all the sessions you wish to register for:

Jan. 24, 2008: Improving the Safety of Seniors
Feb. 27, 2008: Alcohol-Related Civil Liability: The Current State of Ontario Law

How did you hear about the SMARTRISK Learning Series?

Email broadcast or listserv Spotlight Newsletter
Ontario Injury Prevention Resource Centre website Professional Network (please specify):
SMARTRISK Navigator website Other (please specify):

Would you like to receive updates on future sessions and other related information? (Your email address will not be given to any organization outside of OIPRC and SMARTRISK.)
Yes, please send me email updates.
No, please do not send me email updates.

Last updated on September 12, 2007