2016 Drainage Engineers Conference –

Conference Registration Form

Conference Registration Form – Friday, October 21, 2016

Name

Company

☐Home ☐Business

Address

City

Province/State

Postal/Zip Code

Phone

Email

Register

  • The Conference fee includes parking, continental breakfast, lunch, refreshment breaks and Conference Proceedings on CD. Print Conference Proceedings may be ordered separately.

☐Friday Conference: $175.00 + $22.75 HST = $197.75

☐Friday Student Fee: $30.00 + $3.90 HST= $33.90 Student ID#

☐Print Proceedings: $20.00 + $2.60 HST = $22.60 x # = $

☐Open Learning Bursary $

☐Virginia L. Gray Memorial Bursary $

Total: $

Please identify any dietary requirements or allergies:

Please provide payment information on page 2.

Payment

☐Cheque (payable to the University of Guelph)

☐Invoice

Attention to:

PO #

Mail to:

☐Same address as above

☐Mail to this address:

Credit Card

☐VISA

☐MasterCard

Card #:

Expiry:

Cardholder’s Name:

Three-Digit Security Code:

Authorizing Signature:

Send To

DrainageEngineers Conference

Open Learning and Educational Support

160 Johnston Hall, University of Guelph
Guelph Ontario N1G 2W1

Phone: 519-767-5000  Fax: 519-767-1114  email:

2016 Drainage Engineers Conference
Open Learning and Educational Support, University of Guelph 160 Johnston Hall, University of Guelph, Guelph Ontario N1G 2W1 Ph: 519-767-5000  Email:

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2016 Drainage Engineers Conference –

Conference Registration Form

Cancellation Policy:A refund, less a $35.00 administration fee will be issued provided written notification of withdrawal is received by Open Learning prior to September 15, 2016. No refunds will be issued after this date.

Privacy: We are committed to protecting your privacy. The personal information collected on this form will be used for registration purposes, for creating learner profiles, and for sending you relevant Open Learning information we believe may be of interest to you. For further information or to find out how to opt out of receiving future Open Learning information, call us at 519-767-5000 or visit:

Open Learning Bursary: Staff and friends of the University have established and contribute annually to bursary funds to assist students in need. We invite you to consider making a donation to one of these funds by adding your donation amount on the registration form. For further information about the bursaries visit:

2016 Drainage Engineers Conference
Open Learning and Educational Support, University of Guelph 160 Johnston Hall, University of Guelph, Guelph Ontario N1G 2W1 Ph: 519-767-5000  Email:

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