Workshop Registration Form
Use only one form for each participant.
Please record all information as you would like it to appear on all materials.
(* indicates a mandatory field)
If you prefer to fax us this form, simply complete it, print it out, and fax it to us at (613) 569-8846.
Participant Information
First Name *
Last Name *
Organization *
Title or Position

Address 1 *

Address 2

City *

Province *

Country

State/Region (if not in Canada)

Postal/ZIP Code

Telephone *

Fax

Email Address




Workshop Selections

Workshop
Preferred Dates & Location
Price
Click
Amount
Creative Media Relations

$429
Crisis Management
$429




Payment
(all amounts in $CDN)

Subtotal =        GST or HST =        Grand Total =

Method of Payment: *

Purchase Order Number

P.O. Transmittal Method
-or-

Credit Card Number

Expiration Date

Name of Card Holder (check here instead if IDENTICAL to name entries at top of form)

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