Registration Form-AGM 2012 by xiagong0815


									                             REGISTRATION FORM

Please reserve _______ tickets for the following personnel who will be attending the 54th
Annual General Meeting of the New Brunswick Road Builders & Heavy Construction
Association being held at the DELTA Hotel in Fredericton, Tuesday and Wednesday,
January 10th & 11th, 2012.

Registration Fee to all Events: $390.00 per person plus H.S.T.

Registration Fee if three or more delegates attend: $360.00 per person plus H.S.T.

Telephone: (506) 454-5079
Fax: (506) 452-7646
Names: ____________________________               _________________________________
         ____________________________             _________________________________
         ____________________________            __________________________________
         ____________________________            __________________________________
Will you be attending the Wednesday morning seminar?                    Yes        No
                                 METHOD OF PAYMENT
Payable by cheque, VISA or Mastercharge. Your NBRB&HCA registration package includes
admission to all business sessions and all meals and scheduled events included in the conference
program which runs from Tuesday, January 10th through Wednesday, January 11th, 2012.

        Name of Cardholder: _____________________________________
        Signature of Cardholder: __________________________________
        E-mail Address: _________________________________________
        Telephone No. _______________________
        Card No.: ______________________________________________
        Expiry Date: __________________       Amount: _______________

Date: ______________________

Name of Company: _______________________________________________________
Address:             _______________________________________________________
Phone Number:        ______________________

Please note: Registration Fee also includes one copy of the 2012 Equipment Rental
             Rates Guide & Membership Guide.

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