IPAC EO Additional Representative Registration

IPAC Eastern Ontario

Complex IPAC Issues, Local Solutions

Friday, September 21, 2018 from 9:00 am - 4:00 pm

Italo-Canadian Club, 1174 Italia Lane, Kingston

Additional Company Representative: $50.00

REGISTRATION FORM FOR ADDITIONAL COMPANY REPRESENTATIVE:

Please complete the following registration form to exhibit at this event. Payment may be made by cheque or by credit card, via PayPal. You will be prompted for your choice during the registration process.

A confirmatory email will be sent to you. Please note, this email might be located in your SPAM email box.

First Name*

Last Name*

Address*

Address 2*

City*

State/Province*

Zip/Postal Code*

Email Address*

Phone*

Please indicate food allergies and/or dietary restrictions, if any:

Please choose luncheon option:*

IPAC EO Education Day Industry Additional Representative Registration*

$50.00

Company/Organization/Facility:*

Status:*

Delegate

Exhibitor

Speaker

Planning Committee

Payment Type

Total

IPAC Eastern Ontario
President: Meghan Engbretson MSc CCRP CIC
Children’s Hospital of Eastern Ontario
401 Smyth Rd
Ottawa ON K1H 8L1
ipaceasternontario@gmail.com