Online Registration Form

A. Identification

Salutation:

First Name:*

Last Name:*

Address:*

City:*

Province/State:*

Postal/ZIP Code:*

Country:*

Telephone:*

Fax:

E-mail:*

Where did you hear about this Public Conference?

Please check here if you do not want your address to appear on the list of participants which may be distributed to participants.

B. Special Needs

Please indicate any special needs (hearing impairment, wheelchair access, etc.):

C. Registration Fees



Before April 15, 2016	Before May 3, 2016	After May 3, 2016	TOTAL $
$90 CAN	$105 CAN	$120 CAN

All fees are shown in Canadian funds. The Public Day registration fees includes access to sessions, continental breakfast, buffet lunch, coffee breaks and the documentation.

Total Registration Costs

D. Method of Payment

	Online Credit Card Payment (VISA, Mastercard or American Express only)
	Certified Cheque/Money Order/Bank Draft (Please make payable in Canadian funds to "O'Donoughue & Associates Event Management Re : BRCA2016")
	Credit Card Payment by Fax

Full refunds, less an administrative fee of $25.00, will be made for written cancellations received by May 3, 2016. No refunds will be issued for cancellations received after that date.

I have read and acknowledge the cancellation policy.

To complete your registration click:

To print this form for your records:

To erase all entries click:

Public Conference

Online Registration Form

A. Identification

B. Special Needs

C. Registration Fees

FULL DAY REGISTRATION

D. Method of Payment