Registration Information:

Your Name (required)

Your Position

Your Organization

Your Mailing Address including Postal Code (required)

Your Phone # (required)

Your Email (required)

Package Selection:
The following packages are available. Note: Early Bird Discount Offer applies to confirmed registrations received before July 30th, 2010. See details below.

FULL CONFERENCE - November 16th – 18th, 2010
Includes full conference, all sessions, Best Practices/Wine & Cheese event on the 16th, snack breaks, 2 breakfasts, 2 lunches and 2 dinners.
EARLY BIRD PRICING: $486.72 plus HST = $550.00 – if paid by Sept.17th, 2010
AFTER SEPTEMBER 17th: $525.00 plus HST = $593.25

DAY RATE - For any single day of the conference
Includes that day’s conference breaks & meals.
EARLY BIRD PRICING: $287.62 plus HST = $325.00 – if paid by Sept.17th, 2010
AFTER SEPTEMBER 17th: $309.74 plus HST = $350.00

Please select one of the following conference packages based on the information above. (required)

---1. Full conference - November 16th – 18th, 20102. Day Rate - Nov 16 only3. Day Rate - Nov 17 only4. Day Rate - Nov 18 only

Accommodations:
Accommodation is the only additional conference cost. The Blue Mountain Inn is offering an exceptional room rate of $99.99 per night (plus taxes) for your conference accommodation. Call The Blue Mountain Inn directly at 1.877.445.0231 or email at mail@bluemountain.ca and indicate that you are attending the Passport to Citizenship Conference to receive this special rate. Check out Blue Mountain Inn on their web site www.bluemountain.ca.

The always popular Best Practices/Wine & Cheese Event – November 16th, 2010
An excellent opportunity to share resources, meet new people and network with colleagues from around the province.

My organization will have a display and require a table.
 Yes No

Payment:
Conference Registration will be confirmed when payment is received.
A $25.00 processing fee will be charged for payments received after November 4, 2010.

Payment Preference: (required)
 I will mail a cheque I will phone with credit card #

Payment by Credit Card
Please contact Vickie at our Finance Dept: 705-653-1821 Ext: 206 to secure your payment. Do not include credit card information on this form.

Payment by Cheque
Please indicate registrant name on cheque. Cheques to be made payable to:
Community Living Campbellford/Brighton
65 Bridge St. East, P.O. Box 1360,
Campbellford, ON K0L 1L0

Comments or Questions:
Your Passport to Citizenship Conference 2010 team looks forward to seeing you again this year. Please enter any comments or questions in the text area below. You can also contact us anytime at admin@communitylivingcampbellford.com

Cancellation & Refund Policy:
All cancellations and requests for refunds of conference fees must be made in writing and submitted to the Passport to Citizenship Conference 2010 team. Cancellations received by October 29, 2010 are refundable, minus a $75.00 administrative fee per person. After October 29, 2010, cancellations are subject to the entire fee. Please note that if you do not cancel and do not attend, you are still responsible for payment. Substitutions may be made at any time.

Form Confirmation: (required)
Please answer the following question to complete this form.

What colour is fresh fallen snow?