Register by Mail/Fax - Canadian Association of Orthodontists

2015 REGISTRATION FORM
FOR ORTHODONTISTS AND
POST GRADUATE STUDENTS
CAO 67TH ANNUAL SCIENTIFIC SESSION
September 17-19, 2015 • Fairmont Empress Hotel and Victoria Conference Centre • Victoria, British Columbia
You can register in
one of three ways:
●
❶
Contact Information:
●
❷ Fax:
On-line via secure server
http://cao-aco.org/Conference
(416) 491-1670
●
❸
Mail: Canadian Association of Orthodontists
2800 - 14th Avenue, Suite 210, Markham, ON L3R 0E4
(as it will appear on your name badge)
First Name:
Last Name:
Name of Orthodontic Practice:
Office Address:
City:
Phone
Province:
Fax:
(please include area code):
Postal:
(please include area code):
Is this your first CAO Conference? ❍ Yes ❍ No
Email:
Are you planning on attending the AGM on Saturday, September 19th? ❍ Yes ❍ No
Orthodontic Graduate School
Attending Alumni Reception on Saturday, September 19th? ❍ Yes ❍ No
Allergies/Dietary Restrictions
(A) REGISTRATION FEES
Early Bird
Regular
Late
On or before May 31st
June 1st–July 15th
July 16th–August 15th
CAO Members **
$210.00
$295.00
$385.00
TOTAL
$
AAO Members (not residing in Canada)
$555.00
$720.00
$785.00
$
Non-CAO/AAO Member Orthodontists
$785.00
$875.00
$945.00
$
CAO Post Graduate Student Members
N/C (CC # required)†
$165.00
$215.00
$
CAO Life Active/Life/Retired Members ** N/C (CC # required)†
$165.00
$215.00
$
REGISTRATION TOTAL (A)
$
**Includes President’s Welcome Reception Ticket
(B) FUNCTIONS (AVAILABLE TO CONFERENCE REGISTRANTS & GUESTS ONLY.
HOTEL RESERVATIONS
FOR HOTEL RESERVATIONS, PLEASE CONTACT THE
FAIRMONT EMPRESS HOTEL, RESERVATIONS DEPARTMENT AT 250-384-8111 OR https://rresweb.passkey.
com/go/caorthodontists2015.
PLEASE BE SURE TO MENTION YOU ARE WITH THE
CAO CONFERENCE 2015.
PLEASE SEE GUEST POLICY ON
THE RIGHT SIDE OF THIS FORM*)
Date
Time
■ Thursday, September 17, 2015 8:30 am – 3:00 pm
Event Name
Price
$
Tour 1: Whale Watching
$99.00
$
10:30 am – 4:00 pm Tour 2: Touring the Garden City
$125.00
$
7:30 am – 4:00 pm
CFAO Charity Golf Tournament
$250.00
$
6:00 pm – 7:30 pm
President’s Welcome Reception
$38.00
$
$60.00
$
Round Table Breakfast Presentation $38.00
$
8:00 pm – 11:00 pm CAO Speakeasy
■ Friday, September 18, 2015
7:00 am – 8:15 am
$
7:00 pm – 11:00 pm President’s Banquet:
A Touch of Victorian Elegance
$
GST #12620 7950 RT0001
$90.00
FUNCTIONS TOTAL (B)
$
SUBTOTAL (A) + (B)
$
5% GST (BC)
$
CONFERENCE TOTAL
$
† Credit Card numbers are required to hold all registrations. If a registrant does not attend or does not
cancel their registration by August 15th, 2015 an administration fee of $200 will be applied. All cancellations will be given a confirmation number by the CAO
Conference Office.
PHOTO POLICY
In registering for the CAO Conference, you acknowledge that photos or images of you may be taken
during the course of the conference. You further
acknowledge that these photos may be used for
promotion of this and future conferences. They will be
used solely for CAO purposes.
Payment:
■ Cheque or money order enclosed payable to: Canadian Association of Orthodontists
■ Please charge my credit card
Card Number
■ Visa
■ MasterCard
Expiry Date
*GUEST POLICY
A guest is defined as a spouse or significant other who
is not in an industry-related occupation. Orthodontists,
co-workers or associates must be registered for the
conference to attend any functions.
CANCELLATION POLICY
Refunds will be issued for cancellation of registrations
and ticketed events received in writing at the CAO Conference Office prior to August 15th, 2015. No refunds
will be issued after this date.
Table Preferences:
1) _____ 2) _____ 3) _____
12:15 pm – 2:00 pm New & Younger Members’ Luncheon $0.00
Registration Includes:
Full annual meeting fees include access and meeting
material to Friday and Saturday sessions, plus the following: access to Trade Show Exhibits, refreshment
breaks, Lunch in Exhibit hall on Friday and Saturday,
delegate breakfast Friday, AGM breakfast Saturday,
New & Younger Members Meeting & Luncheon on
Friday, printed program and delegate bag.
/
Print Name on Credit Card:
PRIVACY POLICY:
The conference produces an on-site conference program which includes the following office information
of registered delegates: full name, address, telephone,
fax and email. This information will not be used for any
other purpose by the CAO.
❍ Yes, you may use my contact information
❍ No, please do not use my contact information
Signature:
By signing, I authorize the use of my credit card. Please note: all credit card charges will appear under the name of Association Concepts Inc.
Signature