Attend an Event Hosted outside of OTN Form

Attend an Event Hosted Outside of OTN Form

Upon completion, this form will automatically be sent to the scheduling office once you click “submit” at the bottom of this page.”
Requestor First name: Last name: Telephone: Email: Site name: Site number/System number: Address: City, Prov: Postal code:	Billing Information First name: Last name: Title: Phone: Email: Organization: Address: City, Prov: Postal code:
Event Details Name of Event:	Speaker/Presenter Name:
Date of Event: / MM / DD YYYY	Start time: : End time: :
Host Information Location: Contact:	Additional Information Attached (ie. poster):
Fees Members wishing to attend an educational or administrative session outside of OTN will be charged an hourly access fee of $50/hr payable to the Ontario Telemedicine Network. If multiple OTN sites join, the fee is reduced to $40/hr. All non-member systems must be certified with OTN. For those systems not already certified, a system certification and testing will be necessary and the member will be charged a one-time fee of $50. Quotations will be provided and must be approved before the session will be scheduled. If the non-member host agrees to cover the charges, no access fees will be incurred by the member. In this event, please provide billing information for the non-member host in the space provided above.
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