PLP Registration Fall 2012

Deadline for registration is September 10, 2012.

Registration fee is $4,025.

Because we do not have an online payment option, please print a copy of this form, before you submit it online, and mail it along with a cheque payable to "University of Toronto" to the address below:

Institute of Health Policy, Management and Evaluation
University of Toronto
Physician Leadership Program Fall 2012
155 College Street, Suite 425
Toronto, ON  M5T 3M6

tel: 416-978-4326
fax: 416-978-7350
email: physician.leader@utoronto.ca
web: www.ihpme.utoronto.ca/about/conted/plp.htm

Hitting the "Next" button will take you to a Response Preview page which you will be able to print (for mailing with your cheque) before you hit the "Submit" button.

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First Name
Last Name
Position
Department
Hospital / Healthcare Organization
Address 1
Address 2
City
Province
Postal Code
Telephone
Fax
Email
 
Assistant's Name
Assistant's Telephone
Assistant's Email
 
Courier Address - for delivery of Program Materials (if different from above)
Street
City
Province
Postal Code
Accommodation - please select dates required. Cost is $185.00 per night plus applicable taxes. You will be invoiced separately for accommodation.
Date(s) Accommodation Required
None
Wednesday, October 10
Thursday, October 11
Friday, October 12
Wednesday, November 14
Thursday, November 15
Friday, November 16
 

  • The University maintains program effectiveness by limiting the program numbers to a maximum of 35 participants and requires a minimum of 20 participants.
  • Program tuition includes all study materials, continental breakfast and lunch, and dinner where appropriate.
  • In the event of cancellation before the program begins, tuition will be refunded less any requirements for hotel commitments and a $150 administration fee. A 50% refund will be issued for cancellation within 4 days of the beginning of the program unless a substitution is arranged.