Delegate Registration Form
STEP 1: Personal Details
(Please print clearly)
☐ Prof.
☐ Dr.
☐ Mr.
☐ Mrs. ☐ Ms. (please check one)
First Name:
Last Name:
Title:
Company:
Address:
City:
Prov/State:
Country:
Postal Code/Zip:
Phone:
Fax:
Email:
Please check one of the following that best describes you:
☐ Primary producer
☐ Packer/Processor
☐ Feedlot Backgrounder
☐ Government
☐ Retail/Food Service
☐ Financial Institution
☐ Agri-business
☐ Industry Association
☐ Student/Educator/Researcher
☐ Other:
STEP 2: for Platinum Level sponsors only:
☐ Check box for one table of 8 persons at discounted price of $1380.00 CDN plus GST.
Please list the 8 persons to be registered at that table: please include company name in space provided.
1. ___________________________________
2. ___________________________________
3. ___________________________________
4. ___________________________________
5. ___________________________________
6. ___________________________________
7. ___________________________________
8. ___________________________________
Registration Times:
Tuesday, November 26, 2013 from 7:00 pm – 9:00 pm
Wednesday, November 27, 2013 from 7:00 am on through the day.
Session Times:
Tuesday, November 26, 2013, Opening Reception & Guest Speaker 7:00 pm – 10:00 pm
Wednesday, November 27, 2013, Forum 8:00 am – 5:00 pm
Registration fee includes the Tuesday reception cost (cash bar available) and the Wednesday continental
breakfast, 2 coffee breaks and lunch.
Early registration prior to September 6, 2013
Canfax Member, Producer:
$175.00 plus GST
Canfax Member, Industry:
$195.00 plus GST
Canfax Member, Government:
$195.00
Non Member, Primary Producer:
Non Member, Industry:
Non Member, Government:
$225.00 plus GST
$245.00 plus GST
$245.00
Full registration after September 6, 2013:
Canfax Member, Primary Producer:
$200.00 plus GST
Canfax Member, Industry:
$220.00 plus GST
Canfax Member, Government:
$220.00
Non Member, Primary Producer:
Non Member, Industry:
Non Member, Government
$250.00 plus GST
$270.00 plus GST
$270.00
STEP 3: Registration
Early Bird
Before
September 6, 2013
Canfax Member, Primary Producer:
Canfax Member, Industry:
Canfax Member, Government:
Non Member, Primary Producer:
Non Member, Industry:
Non Member, Government:
Sponsor Forum Table of 8 purchase:
Registration
After
September 6, 2013
Total Due
$183.75
$210.00
_____________
($175.00 plus GST)
($200.00 plus GST)
$204.75
$231.00
($195.00 plus GST)
($220.00 plus GST)
$195.00
$220.00
_____________
$236.25
$262.50
_____________
($225.00 plus GST)
($250.00 plus GST)
$257.25
$283.50
($245.00 plus GST)
($270.00 plus GST)
$245.00
$270.00
_____________
_____________
_____________
$1449.00 CDN
($172.50 x 8=$1380.00+$69.00 GST)
_______________
Grand Total
$ _______________
All payments must be made in Canadian funds.
Registration will not be processed or acknowledgements sent until payment is received.
GST# 893865915
STEP 3: Method of Payment
Please choose one form of payment, tick “x” where applicable and complete the details below.
☐1. Pay by Cheque
Make cheque payable to “Iris Meck Communications Inc.” (with a memo of Canfax Forum) in Canadian funds
with all the correct information included and mailed with a copy of the registration form to:
Canfax Cattle Market Forum
c/o Iris Meck Communications Inc.
Suite 510, 5920 - 1 A Street SW
Calgary, Alberta, Canada T2H 0G3
☐2. Pay by Credit Card
(please check one)
☐VISA
☐MasterCard
Credit Card number: _______________________________________________________
Expiry Date (MM/YY): _________________
Name as it appears on the front of the card: _____________________________________
☐ I authorize the use of my credit card
(By agreeing, you authorize the use of your credit card. Your credit card statement will read “Iris Meck
Communications Inc.”)
Cancellation Policy
No refunds will be processed, however, you can substitute attendees by contacting the Canfax Forum office by
phone at: 403-686-8407, fax: 403-255-4592 or by email at: [email protected]
Dietary Restrictions
Please advise of any food restrictions or dietary requirements that need to be met:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Registration Deadline
Registration by phone or fax will close November 25, 2013 at 4:00 pm. Registration will resume and will be
accepted on-site Tuesday November 26, 2013 at 7:00 pm