What’s Next?

Liberal Arts and Sciences Interdisciplinary Conference

October 13 – October 14, 2017

Humber College, North Campus

Registration Fee and Payment Form for non-Humber delegates.

For single or Multiple Registrations

Please Enter Information for Each Registrant
Name:
Dietary
Restrictions:
Package: / ☐ / Option A / Full Conference (Oct. 13 & Oct. 14) / $40.00
☐ / Option B / Keynote Event (Oct. 13) / $25.00
☐ / Option C / Presentations (Oct. 14) / $25.00
Please Enter Information for Each Registrant
Name:
Dietary
Restrictions:
Package: / ☐ / Option A / Full Conference (Oct. 13 & Oct. 14) / $40.00
☐ / Option B / Keynote Event (Oct. 13) / $25.00
☐ / Option C / Presentations (Oct. 14) / $25.00
Please Enter Information for Each Registrant
Name:
Dietary
Restrictions:
Package: / ☐ / Option A / Full Conference (Oct. 13 & Oct. 14) / $40.00
☐ / Option B / Keynote Event (Oct. 13) / $25.00
☐ / Option C / Presentations (Oct. 14) / $25.00

FOR MORE THAN 3 REGISTRANTS, PLEASE USE A SECOND FORM.

Please Enter Registrant Totals
TOTAL NUMBER OF REGISTRANTS PER OPTION
Option A - Full Conference (Oct. 13 & Oct. 14) / $40.00 / = / $
Option B - Keynote Event (Oct. 13) / $25.00 / = / $
Option C – Presentations (Oct. 14) / $25.00 / = / $
TOTAL NUMBER OF REGISTRANTS: / TOTAL
DUE: / $
PAYMENT OPTIONS:
☐VISA ☐MASTER CARD ☐CHEQUE (Made Payable to Humber College)
PLEASE COMPLETE THIS SECTION FOR CREDIT CARD PAYMENTS:
Name on Card:
Card Number: / Exp. Date: / /
Cardholder
signature:
COMPLETED FORMS CAN BE EMAILIED TO:
OR FAXED TO:
ATTN: MELANIE SPARKES
HUMBER COLLEGE (416) 675-3793 / PLEASE MAIL CHEQUE PAYMENTS TO: HUMBER COLLEGE
205 HUMBER COLLEGE BLVD. TORONTO, ON
M9W 5L7
ATTN: MELANIE SPARKES