Attending PHRI Symposium Hamilton

Glad to hear you are attending the PHRI 25th Anniversary International Scientific Symposium:

The Future of Global Health
Please complete the balance of this form and click Submit.

Full Name - Enter your name as shown on your passport.
Title*
First Name*
Middle Name
Last Name (1)*
Last Name (2)
Gender*
Birth Date - Only required if Heming Group is booking your airline ticket.

MonthDayYear
Name Badge*
Institution*
Country*
Travel Information
If you are LOCAL ATTENDEE please select driving in the drop-down menu.

Please contact Karan.chrysler@phri.ca if you require a travel confirmation letter.
Transportation
City/Preferred Airport of Departure
Preferred Airline
Frequent Flyer#
Arrival Date

MonthDayYear
Preferred Arrival Time
Preferred Seating
Preferred Departure Time
Departure Date

MonthDayYear
Passport Details

Only applicable for those booking air travel.
Country of Issue
Passport #
Date of Issue

MonthDayYear
Date of Expiry

MonthDayYear
YesNo
Contact information
Mobile Phone*

Country CodeArea CodePhone Number
Your Email*
Accommodations
Do you require Hotel Accommodation?*
Accommodation will be provided for up to 3 nights at Homewood Suites Hotel for the nights of November 20th, 21st and 22nd, 2024. Additional nights at your own expense. Please request.
Check in Date

MonthDayYear
Check out Date

MonthDayYear
Will you be attending the Art Gallery of Hamilton dinner on November 21st?*
ChickenBeefFishVegetarian
Special Services
Special Dietary Needs
Additional Information
Should be Empty:

Glad to hear you are attending the PHRI 25th Anniversary International Scientific Symposium: