2012 Canadian Conference on Medical Education
(Banff, Alberta)
AFMC - CAME - CFPC - MCC - RCPSC

Global Health and Medical Education:
Beyond Boundaries

April 14 - 18, 2012

If you experience any technical difficulties when using this form, or if you have questions, please contact ProReg Registration Solutions at 250-740-2511, or at ccme@ProReg.ca.

For other conference information please contact Ms. Chriss Holloway at cholloway@afmc.ca or 613-730-0687 ext 240.

The asterisk (*) indicates required field. Use
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SECTION A - DELEGATE OR EXHIBITOR REGISTRATION INFORMATION
 
*Please indicate your affiliation(s)
AFMC
CAME
CFPC
Resident
Medical Student
MCC
RCPSC
Ministry of Health
FMRAC
Non-Medical Student
Other  
*First Name
* Last Name
*Organization
*Mailing Address
 
*City
*Province / Territory / State
*Postal Code / Zip Code
*Country
*Telephone ( )  Ext:
Facsimile ( )
*Email

Once again for 2012…

The CCME Conference has gone Green and in a continuing effort to save trees, there will only be unilingual versions of the final program printed.

Please indicate your language preference:

English French

   
Check this box if you do not wish to have contact information shared with conference exhibitors and sponsors.
   

Dietary restrictions:

Please indicate any food allergies (e.g. seafood, nut)
Please indicate dietary requirements (e.g. vegetarian); be as specific as possible
Please Note: Dietary considerations will only apply to ticketed events excluding box lunches.

Special Requirements:

Please provide us with any details you feel we should know in order to accommodate your participation at this conference.

How did you hear about this conference?

Past Attendee
Colleague
Faculty
Advertising (please specify)
Other (please specify)


SECTION B1 - DELEGATE REGISTRATION
*Registration Category Registration Fee
Online before
Friday
March 16, 2012
Online After
Friday
March 16, 2012
Full Conference Registration $ 695 $ 795
Residents/Non-Medical Students $ 200 $ 275
One Day Registration ~ Saturday April 14 $ 300 $ 350
One Day Registration ~ Sunday April 15 $ 300 $ 350
One Day Registration ~ Monday April 16 $ 300 $ 350
One Day Registration ~ Tuesday April 17 $ 300 $ 350
VIP ~ by invitation only NC NC
CCME Plenary Speaker NC NC
CCME Sponsor NC NC
CCME Staff NC NC
Invited Media NC NC
 

Medical Student Registration

Select University

* Student Identification will be checked at registration on-site.

 

Please check here if you will NOT be attending the conference but wish to only attend the CAME Workshop ~ Scholarship in Medical Education.

Please select the CAME Workshop in Section C below.
SECTION B2 - EXHIBITOR REGISTRATION
Exhibitor registration is for the personnel that will be staffing the booth during the conference. Complimentary registration based on your company (1 registration for non-profit and 2 for profit) will entitle exhibitor access to the conference and lunches on each day there is a box lunch. Additional booth staff are welcome but please register them with the additional cost selected and put payment details in Section D below.
Complimentary Exhibitor Registration $ 0 $ 0
Additional Exhibitor Registration $150 $ 150
  Please put the exhibiting Company Name and or Booth # here:
TOTAL SECTION B1 & B2

SECTION C- SPECIAL EVENTS & WORKSHOPS
For planning purposes please indicate below if you will be attending:
7 - 9 AM Sunday Continental Breakfast ~ (Complimentary)
4 - 6:30 PM Sunday Welcoming Ceremony & Reception

Complimentary box lunches will be offered during the conference to all registered delegates. Please check below if would like a box lunch.
Box Lunch ~ Sunday (Complimentary)
Box Lunch ~ Monday (Complimentary)
Box Lunch ~ Tuesday (Complimentary)
The following special events and workshops require additional registration.

Scholarship and Innovation in Medical Education (SIME) Workshop
Registration is limited to 40 participants.
Friday, April 13
8 AM - 5 PM
 
Co-Chairs:
Vernon Curran, Memorial University of Newfoundland
 
Jocelyn Lockyer, University of Calgary

This workshop, offered by the Canadian Association for Medical Education (CAME), is designed for medical educators interested in undertaking educational research. Described as the systematic study of activities related to teaching, participants will consider their own teaching practice in order to plan a scholarly project. Emphasis will be placed on the role of theory, appropriate methodologies, types of products, venues for dissemination, the importance of peer review and strategies for sustaining a program of
research.

Background: Educational scholarship is described as the systematic study of activities related to teaching.
Important elements include the creation of a product that can be made public, is available for peer review
and can be built upon by other scholars. During this workshop, participants will have the opportunity to
identify an area of investigation arising from their teaching practice. Participants will develop a
research/work plan and consider strategies required to implement and disseminate the resulting products.

Structure: Interactive large group sessions will introduce the fundamental principles of education as
scholarship, elements of scholarly project planning and management. The majority of time will be spent in
small groups with an expert facilitator working on participant's actual projects.

Intended Outcomes: By the end of the day, participants will be able to outline the key principles of a
scholarship project including: clear goals, adequate preparation, appropriate methods, significant results,
effective presentation and reflective critique. Participants will create a clear plan for initiating and
implementing an educational research project. Strategies for sustaining a program of research will also be
considered.

Intended audience: participants should have practical experience as a teacher, clinical supervisor or
program developer and want to develop a plan for a project they intend to undertake.
Level of Workshop (beginner, intermediate, advanced): Beginner and intermediate.

CAME Workshop ~ Scholarship in Medical Education ~ CAME Member
$ 350.00
CAME Workshop ~ Scholarship in Medical Education ~ CAME Non-Member
$ 400.00
Un-select the above choice
 

Monday, April 16
12:15 – 1:45 PM
CAME Awards for Contribution to Medical Education Luncheon and Award Presentations

CAME – Ian Hart Award for Distinguished Contribution to Medical Education
CAME - Meredith Marks New Educator’s Award

Pre-registration is required and tickets will be collected at the door.

CAME Awards-Lecture & Lunch Monday
$ 60.00

Monday, April 16
6:30PM - 10:00PM

YEE-HAW ! IT'S A WILD WEST HOEDOWN!

Pony up to the best western hospitality in the heart of the majestic Rockies. You'll ride to and from the event in city-slicker style. We'll provide the bonfire, chow, and country music for a night of cowboy fun. Throw on your jeans, Stetson and dancing shoes cause after this hearty beef barbecue you'll have enough energy to line dance until the cows come home.

Location: Brewster's MountView Barbecue, Banff

**Transportation will be provided**

Preregistration is required and tickets will be collected at the door.

Social Evening ~ Wild West Hoedown
$ 70.00

Tuesday, April 17
12:15 - 1:45 PM
AFMC Awards-Luncheon – President and CEO’s Address

Chair: Tom Feasby, President, Council of Deans, AFMC

President & CEO’s Address
Nick Busing, President & Chief Executive Officer, AFMC

AFMC – Award for Exemplary Contribution to Faculty Development in Canada
AMFC – Infoway e-Health Award
AFMC – John Ruedy Award for Innovation in Medical Education
AFMC – May Cohen Gender Equity Diversity Award
AFMC – President's Award for Exemplary National Leadership in Academic Medicine
AFMC – Young Educators Award

Preregistration is required and tickets will be collected at the door.

AFMC Awards-Luncheon – President and CEO’s Address
$ 60.00
TOTAL SECTION C 

SECTION D - PAYMENT SUMMARY
Total Fee :
 
 
By Credit Card : VISA MasterCard American Express

(Please note: Your credit card statement will say that payment was made to ProReg Registration Solutions, Nanaimo, BC)
 
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 By Cheque or Money Order

Cheques or Money Orders are made payable to ProReg Registration Solutions. All fees are in Canadian funds.

Mail payment to:

ProReg Registration Solutions
2805 Extension Road
Nanaimo, BC, Canada
V9X 1E8


Additional Invoices
For accounting purposes, if you require your invoice/receipt to be sent to an additional contact, please enter the information below.

Name :
Email :
Fax :
 

SECTION E - CANCELLATION POLICY
 Required Acceptance


Cancellation Policy

Requests for cancellations or substitutions must be submitted in writing to the Conference Secretariat (Ms. Chriss Holloway, cholloway@afmc.ca ) 75% of the registration fee is refundable for cancellation requests received by Monday, March 19, 2012. There will be no refunds after this date, however substitution is permitted.


Submission of this form constitutes acceptance of the conditions of this policy.

Press 'Submit' to complete your registration.

A response page will follow that you may print for your records.

If you experience any technical difficulties when using this form, or if you have questions, please contact ProReg Registration Solutions at 250-740-2511, or at ccme@ProReg.ca.

For other conference information please contact Ms. Chriss Holloway at cholloway@afmc.ca or 613-730-0687 ext 240.