Items marked with an asterisk (*) are required fields.
Title* Mr. Ms. Mrs. Other Other title
First Name* Last Name* Professional Title Organization Address* City* Province/Territory* Postal Code* Daytime Telephone* Fax E-mail*
Registration fee*:
Individual Member $100 Individual Non-member $160 Organization Member: $100 1st attendee / delegate, $80 each additional non-delegate attendee Corporate (non-member) Rate $200 (a tax receipt will be issued for $100)
Method of Payment*:
We would appreciate receiving payment in advance. Please choose one of the following payment methods.
I will mail a cheque payable to "Canadian Working Group on HIV and Rehabilitation" PayPal I will pay in-person when I register
I wish to make an additional donation to CWGHR Amount of donation: $ Please note that a tax receipt will be issued for donations only.
Total amount paid: $
I am a member of CWGHR Please send me information on how to become a member of CWGHR
*Simultaneous French/English interpretation will be provided for all events and workshops. Sign interpretation will be made available on an as-needed basis. The facility is wheelchair accessible.
Evening Reception: 5:30 p.m. – 7:00 p.m.
I will attend I will not attend
Award of Excellence in HIV and Rehabilitation: 7:00 p.m.- 9:00p.m.
8:30 a.m. – 12:30 p.m.
I will not attend
I would like to receive my delegate kit in: English French
Food sensitivities (please specify) ASL interpretation LSQ interpretation Braille editions of background documents Large Print editions of background documents Refrigeration Sharps disposal Other (please specify)
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Contact
Janet London Canadian Working Group on HIV and Rehabilitation +1 416 513-0440 ext. 221 jlondon@hivandrehab.ca
