CCUBC Annual Meeting / CUDBC Congrès Annuel

Due Date:  September 1st, 2015



Registration Form & Invoice / Fiche d'Inscription et facture


44th Annual Meeting
19-21 November, 2015
Holiday Inn Select Hotel Montréal Centre-Ville
Montreal, QC

H2Z 1E9


Deadline for Hotel Reservation is October 8th, 2015
Room Rate: Single /Double occupancy: $149/night
                    Triple /Quadruple occupancy: $169/$189 /night
Reservation: Tel.: 514-878-9888 |Toll Free: 1-888-878-9888


Refer to:(CCUBC)when making reservation


Please fill in this form along with your CCUBC registration payment for 2015 as instructed on the screen / S'il vous plaît, veuillez compléter ce formulaire et y joindre le paiement de votre inscription au CUDBC pour 2015 en suivant les instructions sur l’ecran.

Please help us keep our mailing list up-dated by informing us of any necessary corrections / S’il vous plaît, aidez nous à garder notre fichier à jour en indiquant les changements vous concernant. Merci!


Contact Information of Chair / Coordonnées du Directeur (* Required Fields/Requis)
*First Name /
  Prénom
  *Last Name /
    Nom de famille
*University /
  Université
*Department /
  Département
*Address /
  Adresse
*City /
  Ville
  *Province     *Postal Code / 
    Code Postal 
  Fax /
  Télécopieur
  *Phone /
    Téléphone 
*Email /
  Courriel
*Number of Guests / Nombre d'invités
*Main Dish Choice / Choix de plat principal


Payment Information / Mode de paiement
1 Registration fees, including the banquet / Tarif de registration, inclus le banquet $330 $330
Guest banquet tickets / Billets de banquet d'invité $80 $
     Total $
 
Payment in Canadian funds must accompany this registration.
* Payment Method   Cheque Payment   Credit Card Payment
   Name on credit card

Credit card payments will be processed by PayPal (please note that PayPal accepts VISA, MasterCard and American Express).
Please note once you are transfered to PayPal website to pay by credit card, you will need the full mailing address as shown
on the billing statement for the credit card you are using to pay. You will also need the 3 security numbers available at the back
of the credit card. Other wise PayPal will reject the payment.