Registration

Please fill out the form below.

 

First name:  
Last name:  
Title:  
Business address:  
     
Business email address:  
Business phone number:  
   

TOTAL:

 $30

    

Please indicate if you have dietary restrictions that we should be aware of:

  
     

Payment
Please print and mail your registration form and a cheque or credit card information to:
Lisa Kerr, SW101, UOIT, 2000 Simcoe St. N., Oshawa ON L1H 7K4. Make cheque payable to UOIT.

IMPORTANT: PRINT THIS FORM, then complete the payment information below on the printout if paying by credit card AND click SUBMIT button below. Mail your printed form with proper payment to the address above.
       
  Type of card:   ___________________________________
  Name on card:   ___________________________________
  Number on card:
   ___________________________________
  Expiry date:   ___________________________________
       
 

Signature

   ___________________________________