Quebec Congress in Adaptation-Rehabilitation Research

Uniting Forces and Excellence in Physical Rehabilitation Research

Hôtel Mortagne

1228 Rue Nobel, Boucherville, QC

J4B 5H1

Congress Registration Form

The Congress fees for Thursday and Friday May21-22, 2015are$75 for student members and collaborator members, $130for researcher members and $160for non-members. These fees include participation at the conference, meals (breakfasts, lunches) coffee breaks and cocktail. However, they do not include travel costs, accommodation and other living expenses. Parking and high speed Internet are free at the Hôtel Mortagne.

Name :

Professional address:

City:Province:ZIP Code :

Phone :

E-mail:

Organization(s) you are member:

REPAR CRIR CIRRIS INTER RQRV CRIUGM

Research Centre CHU Sainte-Justine Research Centre on Aging CSSS-IUGS None

Food allergies:

STATUS / I will be present during the following activities:
Researcher members
($130) / Student members ($75) / May 21: AM and PM conferences / Yes / No
Collaborator members (clinician, administrator, research assistant, …)
($75) / Non-members ($160) / May 21: Lunch / Yes / No
May 22: AM and PM conferences / Yes / No
May 22: Lunch / Yes / No
May 21: Cocktail (PM) / Yes / No
May 21: CRIR Researchers Assembly (during lunch) / Yes / No
Comments: / May 22 : General Assembly of the REPAR (during breakfast) / Yes / No
May 22 : General Assembly of INTER (during lunch) / Yes / No

Quebec Congress in Adaptation-Rehabilitation Research

Uniting Forces and Excellence in Physical Rehabilitation Research

Hôtel Mortagne

1228 Rue Nobel, Boucherville, QC

J4B 5H1

You can send your Congress Registration Form by e-mail ator by fax at (514) 340-2154 before Monday, April 6, 2015.For registration fees, please make your check payable to the Institut de réadaptation Gingras-Lindsay-de-Montréal a/s of REPARand send it by mailtogether with your registration form, before Monday, April 6, 2015, at the following address:

Mme LucieBenoît /Bureau de coordination du REPAR

Institut de réadaptation Gingras-Lindsay-de-Montréal

6300, avenue Darlington

Montréal (Qc) H3S 2J4

Late registration will be subject to availability.

Accomodation

Would you like to stay at the hotel during the Congress? We have a discount to reduce the cost of your stay. The cost for one night is $ 155.00 (single or double). A charge of $ 20.00 will be charged for each additional person in the room. The Hôtel Mortagne offers free high speed Internet and free parking during your stay.

To make a reservation, simply call at (450) 655-9966 or toll free at 1-877-655-9966 or send an email at . You will then need to identify yourself as part of the group Congrès Réadaptation 2015, confirmation number # 15269, to benefit from the preferential rate.Your reservation must be done before 6 April to benefit from the preferential rate.

In order to allow us to know the number of room reservations, please indicate if you plan to make a reservation at Hôtel Mortagne:

WednesdayMay 20, 2015 / Yes / No
Thursday, May 21, 2015 / Yes / No
Friday, May 22, 2015 / Yes / No

For information:

Quebec Congress in Adaptation-Rehabilitation Research

Mme Lucie Benoît /Bureau de coordination du REPAR

Institut de réadaptation Gingras-Lindsay-de-Montréal

6300, avenue Darlington

Montréal (Qc) H3S 2J4

Phone: (514) 340-2771

E-mail:

Website: