* Name
* Title
* Company
Postal Address
City
Province/State
Country
Postal/Zip Code
* Telephone
* Email
* I first heard about this conference in		Select one of the following 1. Insurance-Canada.ca email or website 2. CI Canadian Insurance magazine ad 3. From a conference speaker or sponsor 4. Through an industry association 5. A colleague or other
Delegate # 2 Delegate # 3 * Name * Name * Title * Title * Email * Email Delegate # 4 Delegate # 5 * Name * Name * Title * Title * Email * Email If anyone, in addition to the Delegates listed above, should receive an email confirmation / invoice for this registration, please complete the following fields: Name #1 Email Name #2 Email
Number of Attendees Conference Fees Taxes Due (Click one) Canadian Organization – 5% GST due (#896155777) GST Exempt Canadian Organization (See note # 3 below)         * Enter GST tax-exempt number Non-Canadian Organization / Registrant (See note # 4 below) Total fee payable Conference fee is $695.00 plus 34.75 for single registrations or 625.00. each + 5% G.S.T. for multiple registrations. G.S.T #896155777 All fees listed in Canadian currency.
Payment
Please see notes below
I will be paying online with one of the following credit cards.
I will be paying by cheque.

Notes

1. An Invoice and Registration Confirmation email will be sent to Delegate #1 above and anyone listed as doing registrations for others. Delegates #2 through #5 will receive a Personal Registration Confirmation by email.
2. Refund Policy: Refunds will be given for cancellations received in writing by January 15, 2010 subject to an administration fee of $50.00 plus $2.50 GST for a total of $52.50. Registrations after January 15, 2010 are firm. Registered Delegates who do not attend are liable for the full registration fee. Delegate substitutions are welcome at any time.
3. A few, mostly government, Canadian entities are exempt from paying GST. We will need your GST tax-exempt number.
4. If you and your credit card are from outside Canada – as determined by your billing address – you are not subject to the GST. The on-line payment system will not add the GST to the base amount if your credit card billing address is outside Canada.
5. The above amounts are in Canadian dollars; if you are paying on-line by credit card, your credit card company will convert your payment from Canadian dollars to your currency. If you are paying by cheque, cheques must be in Canadian or U.S. funds for the above amount.
6. Questions: Contact Doug Grant, Principal, Insurance-Canada.ca Inc. (416) 921-7756 doug.grant@insurance-canada.ca