The Westin Harbour Castle 1 Harbour Square Toronto, ON M5J 1A6 March 26 & 27, 2012
Registration Form
(One form per registrant. Please register by February 10, 2012.)
Name: ______________________________
City: __________________________________
Title: ______________________________
Address: _______________________________
Company: ___________________________
Province/St: ____________________________
Phone: _____________________________
Country: _______________________________
Fax:
Postal/Zip: _____________________________
______________________________
Email: ______________________________
Payment Options cost per person $149.00 (includes all applicable taxes) Online registration available at www.macdonaldlaurier.ca/conference-2012-moving-canada-ahead PASSWORD: fuels2012
Cheque Please make cheque or money order payable to Macdonald-Laurier Institute. (CDN dollars only) Credit Card:
Visa
Mastercard (3 digits on reverse)
Card #: __________________________________ Exp. Date: _________________ CID#: ______ Card holder name: ___________________________ Company:___________________________ Signature: _______________________________________
(IF DIFFERENT FROM ABOVE)
Billing Address: _________________________________________ Phone: ______________________ City: _________________________________ Prov/St: ________ Postal code / Zip: ___________ You will receive a confirmation notice when your registration is processed. Registration is not guaranteed until reception of payment. Cancellation policy: No refunds are available after February 25, 2012.
Send Completed form to: Macdonald–Laurier Institute, 8 York St, Suite 200, Ottawa ON K1N 5S6 or Fax to (613) 236-4280 For more information, please contact: Robin Bourke Ph:(613) 482-8327 ext. 101 Email:
[email protected]
A Macdonald-Laurier Institute event
Sponsored by:
