| Name: |
__________________________________________________________________
|
| Title: |
__________________________________________________________________ |
| Organization: |
__________________________________________________________________ |
| Address: |
__________________________________________________________________ |
| City: |
__________________________________________________________________ |
| Postal
Code |
__________________________________________________________________ |
| Phone Number: |
__________________________________________________________________ |
| Fax Number: |
__________________________________________________________________ |
| E-Mail
Address: |
__________________________________________________________________ |
| __ |
Member:
Individual
- $195.00
PLUS 5% GST |
| __ |
Member:
Table of
8 - $1560.00
PLUS 5% GST |
| __ |
Non-Member:
Individual
- $245.00
PLUS 5% GST |
| __ |
Non-Member:
Table of
8 - $1960.00
PLUS 5% GST |
| Method
of Payment |
(OCRI GST
#122847510) |
Cheque
(payable to OCRI/LSAWARDS) |
__________________________________________________________________ |
| MasterCard |
__________________________________________________________________ |
| Visa |
__________________________________________________________________ |
| AMEX |
__________________________________________________________________ |
| Card Number |
__________________________________________________________________ |
| Expiry
Date |
__________________________________________________________________ |
| Cardholder
Name |
__________________________________________________________________ |
| Signature |
__________________________________________________________________ |
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registering for this event you will automatically be added to the OCRI mailing
list.
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