CONFERENCE/SEMINAR REGISTRATION FORM FOR SUPPLIER TO GOVERNMENT DELEGATE
Please fill out the registration form and click the submit button below. For security purposes please contact us by phone with your credit card number at 416-241-4000 x 224.
* denotes required fields
Tax Exemption Number:   Please enter Tax Exemption Number if applicable.
DELEGATE CONTACT INFORMATION
First Name: *    
Last Name: *  
Job Title: *    
Job Function:  
Email Address: *     
Telephone: * (  ) - Ext:
Facsimile: (  )  - 
ORGANIZATION INFORMATION
Organization Name: *   Name of company
Department Name:   ie: marketing, accounting, sales
Company Size:
Address 1: *
Address 2:  
City:*  
Province/Territory/State: *  
Postal Code/Zip *  
Country: *
How did you hear about us: *  
PRICING INFORMATION
Price: (Early bird rate)
Early Bird: Register Before May 31st, 2012 & Save $200 Off the Regular Price of $1595
Number of Delegates: * Group Rate:
4 can attend for the price of 3
(for more info call: 416-241-4000 x 221)
Sub-Total: * $1395
13% HST: * $181.35
Total: * $1576.35
PAYMENT INFORMATION
Payment Type: *

VISA

MasterCard
For credit card payments please call us with your credit card information at 416-241-4000 ext.224.

If you are paying by cheque, please send payment to:
NCM EVENTS
59 The Westway
Etobicoke, Ontario
M9P 2B4 Canada
BILLING INFORMATION
  Fill in Only if billing information is different than above
First Name:  
Last Name:  
Organization Name:  
Department Name:  
Email Address:   
Telephone: (  ) - Ext:
Facsimile: (  )  - 
Address 1:
Address 2:  
City:  
Province/Territory/State:  
Postal Code/Zip  
Country: