Registration

Please fill out the form below to register:

Name* (required)
Address* (required)
City* (required)
Province* (required)
Postal code* (required)
Telephone* (required)
Fax
Email* (required)
   
TICKET PRICE (CAD) : $300 EACH Number of Tickets Required
* If you make a donation without purchasing tickets please indicate 0 in the "number of tickets" field
DONATION (CAD) $ (With Tax Receipt)
METHOD OF PAYMENT:
1. CHEQUE PAYABLE TO:

THORACIC SURGERY Research Foundation of Montreal
835, René-Lévesque Est
Montréal, QC, H2L 4V5
Registration #: 85697 2872 RR0001
2. PAY BY CREDIT CARD:

Visa VISA
Mastercard MASTERCARD

 
For further information please contact
Jessica Gauthier at (514) 844-0808