SEMINAR REGISTRATION FORM

Encompass Canada Technical Seminar

Toronto – Tuesday February 20, 2007
Montreal – Thursday February 22, 2007

REGISTRATION FEE WAIVED

To register, please enter your contact information below and e-mail your completed registration form to seminar@encompasscanada.org.  If you prefer to FAX, please print out the completed pages and fax to: 709-834-7846.  Data fields identified with an asterisk (*) need to be filled before your registration can be accepted.  The registration fee has been waived until further notice. 

Please indicate the seminar you wish to attend:

____ Toronto, Tuesday February 20th		____ Montreal, Thursday February 22nd 

Registration Information:

Title, Prefix: __________ (Ms., Mr., Dr., etc.)

First & Last Name*: _________________________________

Occupation or Title*: ________________________________

Organization or Company*: _____________________________________________________

Mailing Address*: _____________________________________________________________

City/Town*: _______________________ Province*: _________ Postal Code*: ____________

Business Phone*: ____________________   Cell/Alternate Phone: ______________________

FAX: _____________________________________________

E-mail*: __________________________________________

Alternate E-mail: ___________________________________

Special needs and requests - please let us know if you require any special needs while you are attending the seminar (e.g. dietary, mobility):
____________________________________________________________________________
____________________________________________________________________________

Seminar registration fee per person:  (fee waived until further notice) 


Method of Registration:

_____ 	By E-mail to seminar@encompasscanada.org  	
_____ 	By Fax (to 709-834-7846)
_____ 	By Postal Mail to:
                		    Technical Seminar Registration
Encompass Canada 
P.O. Box 13132, Station Topsail
Conception Bay South, NL
A1W 2K1