Dermacon

REGISTRATION FORM

FOR DAY OF DERMATOLOGY FOR HEALTHCARE
PROFESSIONALS
STEP 1 / Choose your city and date

STEP 2 / Provide your info
Participant
Name
Company
Please
select one
Address
Permission
Allergies /
Special diet
STEP 3 / Select your payment method
Method of payment
RBC CONSULTANTS
2525 HAVRE DES ILES, SUITE 105 C
LAVAL, QUEBEC H7W 4C6