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Governance Models for Boards Registration Form by mallorycarlson

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									                          Governance Models for Boards
                                  Registration Form
                        (Please complete one form per participant)
Please register using one of the following methods:
Online:
http://shop.1asecure.com/index.cfm?StID=8516&randomnumber=652&CFID=25263477&C
FTOKEN=a58130d04e0cc5b1-DF0B1065-3048-7463-5BA1F3B84549C27C by e-mailing the
Or email the form below to: info@hjwythe.com
Or mail the form below to the most appropriate address:
HELEN J. WYTHE & ASSOCIATES
Suite # 211-3336 Portage Ave Winnipeg, Manitoba R3K 2H9
Phone 204-992-2562 Fax 204-272-3321
HELEN J. WYTHE & ASSOCIATES
Suite # 181-10654 82nd Ave NW Edmonton, Alberta T6E 2A7
Phone 780-628-5669 Fax 204-272-3321
Or fax the form below to 204-272-3321
Participant Cancellation Policy for Public Class Registration: Registration fees are non-
refundable. Non-refunded fees may be applied to another class.
HJW Public Class Cancellation Policy: We will cancel unprofitable public classes two
weeks and two days prior to class. Please purchase plane tickets at two weeks to avoid
non-refundable tickets.
          * We reserve the right to reschedule our workshops due to low registrations.
        * Your fees will be reimbursed or registration rescheduled at no charge to you.*
               THIS COURSE IS LIMITED TO 25 PARTICIPANTS
 YOUR REGISTRATION FOR THE COURSE WILL BE CONFIRMED WHEN PAYMENT IS
                               RECEIVED.
Dates, Locations and Fees
Please indicate below which course you are registering for.

Fee: $125.00 includes light refreshments, a resource manual valued at $50.00 and personal action plan.
For an early bird fee of $100.00 registration and payment must be received in the Helen J. Wythe &
Associates office by March 2, 2009 or
For an Organizational group fee of $100.00 per person per session registration and payment must be
received as follows:
To qualify for organization group rate, each person in your group must fill out an individual registration
form. We must receive all of the organization’s group registration forms together with payment in one
envelope.

Payment Options
Make check payable to: HELEN J. WYTHE & Associates.
Or
Pay Pal/Credit Card is now available at
http://shop.1asecure.com/index.cfm?StID=8516&randomnumber=652&CFID=25263477&CFTO
KEN=a58130d04e0cc5b1-DF0B1065-3048-7463-5BA1F3B84549C27C


Course Choice 
                       Fee                        $125.00 & $ 6.25 = $131.25 (2009)
                       Date                       November 5, 2009 1:00pm to 4:00pm
                       Location                   Thunder Bay, Ontario, Canada (YQT)
                       Date                      April 22, 2010 1 :00pm – 4:00pm
                       Location                  Thunder Bay, Ontario, Canada (YQT)
Registration Deadline: Two Weeks and Two Days Before Course Start Date

Name

Position and
Organization

Address

City, Province,
Postal Code

Telephone and
Fax

E-Mail



 #211- 3336 Portage Avenue Winnipeg, Manitoba Canada R3K 2H9 P: 204.992.2562 F: 204.272.3321
 #181-10654 82nd Avenue NW Edmonton, Alberta Canada T6E 2A7 P: 780-628-5669 F: 204.272.3321
                       E: helenwythe@hjwythe.com W: www.hjwythe.com

								
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