AFCEA Executive Breakfast
Registration Form
June 17, 2009
Please fill out completely
Fax back to 613-721-0092
Featured Speaker
John Turner
Assistant Deputy Minister (Information Management)
National Defence
FEES for June 17, 2009 Breakfast:
Active Duty Military Member $ 25.00 (+ GST)
AFCEA Member (by invitation) $ 65.00 (+ GST)
Table of Ten (10) $ 600.00 (+ GST)
Table of Eight (8) $ 500.00 (+ GST)
Table of Six (6) $ 375.00 (+ GST)
Company Name _________________________________________________________
Name of Contact Person __________________________________________________
Address________________________________________________________________
City _______________________ Prov ________________ PCode ________________
Phone ______________________________ FAX ______________________________
Email Address _________________________________________________
Card Number ________________________________________________ Expiry Date _______________________
□ AMERICAN EXPRESS □ VISA □ MASTERCARD
Date ___________________________________ Signature ________________________________________________
If paying by check □ this form must still be faxed to number above
Mail Check to– AFCEA Ottawa Chapter, 1 Stafford Road East
Nepean, Ontario, K2H 9P6
03 Jan 06