Accueil

First name *
Last name *
Position title *
Organisation *
Address*
City *
Province *
Postal Code *
Phone *	Ex.
Fax
Email *

Special needs? *	Yes No
Yes, precise :

Workshop Selection

Please select which workshop you wish to attend on of the following scheduled periods.

	1^st choice	2^nd choice
2A : Vehicle Adaptations for the paediatric (english only)
2B : Driving skills training for clients with cognitive impairments (bilingual conference)

Registration fee

Pre-confrence: $65

Paiement

Please send cheque payable to “Institut de réadaptation en déficience physique de Québec” to:

Institut de réadaptation en déficience physique de Québec
c/o Secrétariat - Formation réseau
525 Wilfrid-Hamel Bvld. Room H-200
Québec (Qc) G1M 2S8

Your registration fees are confirmed by the date we receive your payment.

Your registration is confirmed and ensured once we receive payment.

Cancelation & substitutions

The registration fees are non-refundable. Registration can be substituted without

additional charges, if notice is given.

I agree with the cancellation and substitution policy.

Site web adapté pour les personnes ayant une déficience visuelle

Votre opinion SVP!