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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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