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The 16th Annual Bertha Rosenstadt National Undergraduate Research Conference in
Kinesiology and Physical Education
March 27, 2015
Registration Form (BC#34390)
Surname_________________________ Given Name _____________________________
Street Address _____________________________________________________________
City ____________________ Prov. ___________ Postal Code ______________________
Day Phone ______________________ E-Mail ___________________________________
University: _______________________________________________________________
I am registering as a:
 Presenter
 Participant
The $35.00 registration fee includes a copy of the conference proceedings, reception,
lunch, and refreshments throughout the conference.
Presenters Only
Title of Presentation: ________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Faculty Advisor: ___________________________________________________________
Audio Visual Requirements:  PowerPoint  DVD  Other: _____________________
Abstracts:
Submit a 500-word single-spaced abstract in Microsoft Word electronic
format to [email protected] by March 6, 2015. Abstracts will be
published in the conference proceedings. Please use the following content
format.
Presentation Title:
Student Researcher:
Faculty Advisor:
Abstract: (APA format recommended)
Please provide payment information on the next page…….
Method of Payment



MASTER CARD
AMEX
VISA
You must authorize the Faculty of Kinesiology and Physical Education to debit your card. Please fill
in the following information.
**I authorize the Faculty of Kinesiology and Physical Education, University of Toronto to debit my
AMEX, VISA or MASTERCARD for the $35.00 Undergraduate Research Conference fee**
Card number: __________________________________Expiry date: ________________________
Card holder's name as it appears on the card:___________________________________________
Card holder's signature:________________________________________Date:________________
Return this form along with your completed application:
By mail
National Undergraduate Research Conference
Faculty of Kinesiology and Physical Education
Registrar’s Office
55 Harbord Street
Toronto, Ontario M5S 2W6
By fax
Attn: Carolyn Laidlaw
416-971-2118
Notice of Collection - Freedom of Information and Protection of Privacy Act
The University of Toronto respects your privacy. The information on this form is collected
pursuant to section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose of
administering the National Undergraduate Research Conference offered by the Faculty of
Kinesiology and Physical Education. At all times it will be protected in accordance with the
Freedom of Information and Protection of Privacy Act. If you have questions, please refer to
www.utoronto.ca/privacy or contact the University’s Freedom of Information and Protection of
Privacy Office at 416 946-5835, Room 201, McMurrich Bldg., 12 Queen’s Park Crescent, Toronto,
ON, M5S 1A1