|
| Please print name to be used on badges |
| Delegate Name |
First:
|
| |
Last:
|
| Companion Name |
First:
|
| |
Last:
|
| Is this your first Annual Business Conference? |
|
Yes
No |
If
No, have you attended within the last past 5 years?
Yes
No |
DELEGATE INFORMATION
Please complete information or attach business card |
COMPANION INFORMATION
Please complete information to register companion |
Name:
|
Name:
|
Title:
|
Home Address:
|
| Company:
|
City:
|
| Address:
|
Prov.:
|
| City:
|
Postal Code:
|
| Prov.:
Postal Code:
|
Tel.:
|
| Tel.:
Fax:
|
Fax:
|
| Email:
* required for confirmation |
Email:
|
| |
| PAYMENT INFORMATION |
Includes all business and companion programs,
PLUS 5 MEALS
|
|
A 5% Discount to be taken if registered and
PAID BY MAY 1, 2008 |
If paid after May 1, 2008 |
Delegate & Companion |
$1,282.00
5% GST + 64.13
TOTAL $1,346.63
|
$1,350.00
5% GST + 67.50
TOTAL $1,417.50 |
|
Delegate
Only |
$807.50
5% GST + $40.38
TOTAL $847.88
|
$ 850.00
GST+ 42.50
TOTAL $ 892.50 |
| |
OPTIONAL ACTIVITIES EXTRA
(Select after registering through this form) |
| PAYMENT
METHOD (REQUIRED) |
Cheque |
Master
Card |
VISA |
AMEX |
Card
Number
(no spaces):
|
* required |
|
| Card Holder Name:
|
|
|
| Expiry Date:
/
|
(GST#10686
1669RT)
Total Amount $
REQUIRED - enter Total from selection above |
| |
|
|
| |
| REGISTRATION PROCESS |
Please complete & forward
along with ACTIVITY CHECK LIST(S) and other applicable forms to:
Canadian
Institute of Plumbing & Heating
295 The West Mall, Suite 330, Toronto, ON M9C 4Z4
By Fax : 416 695 0450
On-line: www.ciph.com/abc |