2009 Annual Conference REGISTRATION FORM
Delegate Name _________________________________ (As it will appear on the name badge) Companion Name ________________________________ (As it will appear on the name badge)
Company Name __________________________________________________________________________________ Address City Telephone ____________________________________________________________________________________ ___________________________ Province ___________________________ E-mail __________________ _____________________________________________
Please indicate any special needs you may have ( ie accessibility, diet, etc.): _________________________________ Is this your first CSCB Conference? Are you a CCS designate? REGISTRATION FEES Delegate Fee includes all conference sessions, continental breakfasts, refreshment breaks, welcome reception and lunches. Companion Fee includes the welcome reception. Golf Fee includes power car and lunch. Fees include 13% HST. (HST# 13183 1323 RT) CSCB Corporate & Associate Member CCS Designates not employed by a Corporate or Associate Member Other Delegate Fee Companion Fee Delegate Fee Companion Fee Delegate Fee Companion Fee $565.00 $ 56.50 X ____ $621.50 $ 67.80 X ____ $ 672.35 $ 84.75 X ____ $ 56.50 X ____ $ 175.15 X ____ $ 50.85 Total Paid ____________ Yes Yes No No CCS number: _______________
Famous Halifax Pub Tour (available only to registered delegates and registered companions, must register by August 24, 2009.) Golf – September 11 (available only to registered delegates and registered companions, must register by August 24, 2009.) CSCB Atlantic Regional Conference (September 11 from 2pm - 5pm)
PAYMENT OPTIONS - If paying by credit card, we will destroy the customer copy of the credit card transaction, unless you request it. If you wish to receive the customer copy, please check this box. Cheque (payable to CSCB) Visa Mastercard Amex Expiry date: _____________________________
Card number: ________________________________________ Cardholder’s name:___________________________________ Signature: __________________________________________
Cancellation Policy: Notice of cancellation must be received in writing by August 27, 2009. No refund for cancellations received on or after August 27, 2009. Substitutions are permitted. Please notify the CSCB as soon as possible if you are planning to make a substitution.
Register by phone at 613-562-3543, by fax at 613-562-3548 or by mail to: CSCB National Office, Suite 320, 55 Murray St., Ottawa, ON K1N 5M3
REGISTRATION IS CONFIRMED ONLY WHEN PAYMENT IS RECEIVED PAYMENT MUST ACCOMPANY YOUR REGISTRATION OR IT WILL NOT BE PROCESSED If you do not receive a confirmation, contact the CSCB National Office at 613-562-3543 or nfares@cscb.ca