Registration Form

40th AMOP Technical Seminar on Environmental Contamination and Response

June 6 to 8, 2017
Venue Pending
Alberta, Canada

Flying to Canada? The entry rules have changed! For further information, visit the Citizenship and Immigration Canada website.

Print and submit


Name _________________________________________________________________________

Organization ___________________________________________________________________

Street ________________________________________________________________________

City _____________________________________   Province/State ______________________

Country __________________________________   Postal Code/Zip _____________________

Telephone ________________________________   Fax _______________________________

E-mail ________________________________________________________________________

Registration Packages and Rates

Complete  Package (includes sessions, poster displays, exhibits, coffee breaks, and lunches for all 3 days, Welcome Reception, and a copy of the Proceedings)

☐ Before May 1- $475Footnote 1

☐ After May 1 - $575Footnote 1

☐ On site - $605Footnote2

Daily Rate

TuesdayWednesdayThursday

☐ Before June 1 (____ x $225Footnote 1) = $__________Footnote 1

☐ On site (____ x $240Footnote 2) = $__________Footnote 2

Student Rate

☐ Before June 1 - $275Footnote 1

☐ On site - $290Footnote2

All prices are in Canadian dollars. To receive the reduced registration rate, payment must be received by May 1, 2017. Make cheques payable to Receiver General for Canada and send along with this form.
If paying by credit card, please fill out the information below.

☐ Cheque       ☐ Visa       ☐ MasterCard       ☐ AmEx          

Total Amount (Canadian Dollars) ________

Card Number:   _____________________________________
Expiry Date: ____________
Card Security Code (Last 3 digits on the back of the credit card): __________
Name as it appears on card: ______________________________________
Authorization signature:   ________________________________________
Tax Exemption number, if applicable _______________________________

Send this form along with payment to:

Natalie Jones
Technical Seminar Coordinator
Emergencies Science and Technology Section
Environment and Climate Change Canada
335 River Road
Ottawa, Ontario, Canada
K1A 0H3

Telephone: (613) 991-1114
Fax: (613) 991-9485
E-mail: ec.colloquetechniqueamop-amoptechnicalseminar.ec@canada.ca

Please contact us if you have any questions.

Footnotes

Footnote 1

5% GST extra , if applicable

Return to footnote 1

Footnote 2

includes taxes

Return to footnote 2

Date modified: