Registration Form Name *Title(s)Email *Job titleProfessional Affiliation *Which of the following occupations best describes you?ClinicianAllied Healthcare Professional (Pharmacist, Dietitian, etc.)Academic ScientistIndustry ScientistStudentCommercial (Business Developer, Sales, Marketing, etc.)Women's Interest/Patient Group RepresentativeMember of the Media/PressOtherPlease provide a few keywords relating to your area of expertise *How did you hear about this conference?EmailColleaguePromotional posterInternet searchSocial mediaWhat burning question(s) would you like to ask to the experts present at the conference? *Do you have any dietary needs/concerns?Would you like to join us for the Public Event celebrating International Women's Day on March 7th after the conference finishes?YesNoI would like more information to decideDo you give permission for your contact information to be shared with the attendees of the 2019 conference? *YesNoSelect one of the following participation options: * Clinician/faculty/non-industry scientist/collaborator - Research day March 7th only (CAD 100,00) Press or Student - Research day March 7th only (CAD 50,00) Industry - Research day March 7th (CAD 500,00) Amount * CAD Payment method * Credit card I hereby give authorization to collect the recurring amount from my account periodically. Register