Annual Meeting Registration Form Please complete all required fields! Title(*) MLT MLA Student Other Invalid Input First Name Invalid Input Last Name Invalid Input NSCMLT # Invalid Input Address Invalid Input Province Please select...Nova ScotiaAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Invalid Input Postal Code (A1A 1A1) Please type your postal code in the following format: A1A 1A1. Phone (123-456-7890) Please type your phone number in the following format: 123-456-7890 Email Invalid Input Discipline Please select...ChemistryCore Lab CytologyCyto-GeneticHaematologyHistologyInformation Management and Technology Support (IM/IT)MicrobiologyPhlebotomyPre-AnalyticalSpecimen ProcessingTransfusion MedicineOther Invalid Input Employer Please select...Atlantic Assisted Reproductive Therapies Aberdeen Hospital(PCHA) Accessible Med Tech Services All Saints Springhill HospitalAnnapolis Community Health Centre Bayview Memorial Health Care CentreBuchanan Memorial Community Health CentreCape Breton Regional Hospital Cape Breton University Capital District Health Authority (CDHA) Canadian Blood Services Cobequid Community Health Centre Colchester Regional Hospital Cumberland Regional Health Care Centre Dalhousie School of Health Sciences Dartmouth General Hospital Digby General Hospital DND - Calian DND - Department of National Defense DND – CFB Halifax Dominion Biological Ltd. East Coast Mobile Medical Inc. Eastern Memorial Hospital Eastern Shore Memorial Hospital Family Practice Associates - Halifax Fishermen’s Memorial Hospital Glace Bay Health Care Facility Guysborough Memorial Hospital Halifax Infirmary Hants Community Hospital Health Info Tech Services for NS Inverness Consolidated Memorial Hospital IWK Health Centre Lillian Fraser Memorial Hospital MacCulloch Med Tech Services MSHJ Research Musquodoboit Valley Memorial Hospital New Germany & Area Medical Centre New Waterford Consolidation Hospital North Cumberland Memorial Hospital Northside General Hospital not applicable NS Agriculture College NS Department of Agriculture NSCC – Waterfront Campus NSCMLT – NS College of Med Lab TechsNSHA Nulabb Blood Collection & Consulting Services Other Precision BioLogic Inc. QEII Health Sciences Centre Queens General Hospital Roseway Hospital Sacred Heart Community Health Centre1 Self Employed Soldiers Memorial Hospital South Cumberland Community Care Centre South Shore Regional Hospital Spryfield Family Medicine Clinic St. Anne’s Community Nursing Care Centre St. Martha’s Regional Hospital St. Mary’s Memorial Hospital Strait Richmond Hospital Tri-County Blood Collection Services Twin Oaks Memorial Hospital Valley Regional Hospital Victoria County Memorial Hospital Yarmouth Regional Hospital Invalid Input Breakfast Social Event Yes No Invalid Input AGM only Yes Invalid Input Dietary Restrictions NoneGluten FreeDiabetic DietNut AllergySeafood AllergyOther Invalid Input Total 0.00 CAD Credit Card Number(*) Invalid Input Expiry Date(*) Invalid Input Expiry Date(*) Invalid Input Card Security Code (CSC)(*) Invalid Input