Delegate Registration Form
STEP 1: Personal Details
(Please print clearly)
☐ Prof.
☐ Dr.
First Name:
☐ Mr.
☐ Mrs.
Click here to enter text.
Title: Click here to enter text.
☐ Ms. (please check one)
Last Name: Click here to enter text.
Company: Click here to enter text.
Address: Click here to enter text.
City: Click here to enter text.
Prov/State: Click here to enter text.
Country: Click here to enter text.
Postal Code/Zip: Click here to enter text.
Phone: Click here to enter text.
Email: Click here to enter text.
STEP 2: Select Registration Category
Please check one of the following that best describes you:
☐ Food Processor
☐ Industry Association
☐ Government
☐ Student/Educator/Research
☐ Retail/Food Service
☐ Financial Institution
☐ Agri-business
☐ Other: Click here to enter text.
Registration Times:
Tuesday, May 26, 2015 from 7:00 am – 9:00 pm
Wednesday, May 27, 2015 from 7:00 am – 10:00 am
Ingredients for Success Conference Times:
Tuesday, May 26, 2015, Breakfast 7:30 am; speaker sessions 8:30 am – 5:00 pm and reception 5:00 pm – 6:00 pm
Wednesday, May 27, 2015, Breakfast 7:30 am; speaker sessions 8:30 am – 12:30 pm followed by lunch
Alberta Food Awards Dinner:
Tuesday, May 26, 2015, 6:00 pm – 9:00 pm
Registration fee includes breakfast, coffee breaks and lunch on both days and the reception on Tuesday
evening.
Ingredients for Success Conference registration fee for industry,
academic, and non-government delegate:
$175.00 CDN Funds plus GST
Ingredients for Success Conference registration fee for government delegate:
Alberta Food Awards Dinner registration fee for industry, academic,
and non-government delegate:
Alberta Food Awards Dinner registration fee for government delegate:
$175.00 CDN Funds
$85.00 CDN Funds plus GST
$85.00 CDN Funds
STEP 3: Registration
Total Due
CDN funds
Ingredients for Success Conference registration fee for industry, academic,
and non-government delegate:
$183.75 Click here to enter text.
($175.00 plus GST)
Ingredients for Success Conference registration fee for government
delegate:
Alberta Food Awards Dinner registration fee for industry, academic,
and non-government delegate:
$175.00 Click here to enter text.
$89.25 Click here to enter text.
($85.00 plus GST)
Alberta Food Awards Dinner registration fee for government delegate:
$85.00 Click here to enter text.
______________________________________________________________________________________
Grand Total
$ Click here to enter text.
All payments must be made in Canadian funds. Registration will not be processed or acknowledgement sent until payment is received.
Conference Registration GST# 834627655RT0001 Alberta Food Awards Dinner Registration GST# 10669-3377-RT
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 “Ingredients for Success” ) in
Canadian funds with all the correct information included and mailed with a copy of the registration form to:
Ingredients for Success 2015
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: Click here to enter text.
Expiry Date (MM/YY): Click here to enter text.
Security code (CCV) on back of card: Click here to enter text.
Name as it appears on the front of the card: Click here to enter text.
☐ 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 Ingredients for Success 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:
Click here to enter text.
Registration Deadline
Registration by phone or web will close Monday May 25, 2015 at 1:00 pm. Registration will resume and will be accepted on-site Tuesday May 26, 2015 at 7:00 am.