 |
Registration Form
Advanced Travel & Tropical Medicine Course Friday, May 18 & Saturday, May 19, 2007 Coast Plaza Hotel & Suites, Vancouver, BC
First Name:______________________________________________ Family Name:____________________________________________
Please Circle: MD RN MR MRS MS Other:___________________
Mailing Address:______________________________________________________________________________________________________
City:_______________________________________ Prov/State:____________________ Country:____________________________________
Postal/Zip:______________________________ Telephone:_____________________________ Fax:__________________________________
Email:____________________________________________________________
( ) Please check this box if you wish for your contact details to be available on the participant list.
REGISTRATION FEES Please note the fees are in Canadian funds.
The delegate registration fee includes general sessions, course syllabus, 2 continental breakfasts, 4 refreshment breaks and 2 lunches.
The daily attendance registration fee includes 1 day of general sessions, course syllabus, 1 continental breakfast, 2 refreshment breaks and 1 lunch.
Prior to April 15, 2007 After April 15, 2007
Delegate
Registration: $350.00 $450.00
$_______________________ Daily Attendance $190.00 $240.00 $_______________________ Friday _____ Saturday _____
```````` ` GST at 6% $_______________________
```````` ` Total Enclosed: $_______________________ METHOD OF PAYMENT ( ) Visa ( )MasterCard ( ) Cheque (Payable to CongressWorld Conferences Inc. & send to the CongressWorld Conferences Inc. mailing address listed below).
Credit Card Number:____________________________________________________________ Expiry:__________________________________
Cardholder's Name:___________________________________________ Cardholder's Signature:______________________________________ Charges on your credit card will appear as CongressWorld Vancouver
NOTE: If sending your registration form via fax, please DO NOT MAIL ORIGINALS to the CongressWorld Conferences Inc. office.
Cancellation Policy: Refunds of the registration fees paid, less a $75.00 CDN administration fee, will be granted if you decide to cancel your registration. Cancellation must be received in writing at the CongressWorld Conferences Inc. office one month prior to the conference date. No refunds will be granted after this date or for non-attendance at the conference.
Hotel Accommodation: A block of rooms have been reserved at the Coast Plaza Hotel & Suites. Please contact the hotel directly if you require accommodation and quote “Advanced Travel & Tropical Medicine” or “CPS-GFC1444” to receive the conference rate. The rate for single/double occupancy ranges from $179.00-$219.00 CDN per night, plus applicable taxes. Please note the rooms will be released on April 18, 2007. Hotel
Address: Toll
Free: 1 800/663-1144 Fax: 604/688-5934 Conference Organizers: CongressWorld Conferences Inc. #404-999 Canada Place Vancouver, BC V6C 3E2 Tel: 604/685-0450 Fax: 604/685-0451 Email: nlamppu@congressworld.ca Website: www.skylarkmedicalclinic.com |
|
|
