Registration Form

Name of Registrant:
University/Organization:
Mailing Address:
City:	State/Province:
Zip/PostalCode:	Country:
Telephone:	Fax:
Email:

1. Register (includes Thursday Welcome Reception, 2 Breakfasts, 1 Lunches, All Breaks, & Friday Night Social Event) Please check appropriate registration fee:
	Postmarked & Paid
	Before / On January 31	After February 1
Physician, Surgeon, Scientist	$900	$975
Medical Student, Graduate Student, Resident, Fellow, Nurse, Allied Health Professional	$400	$450
Industry	$1500	$1500

2. Indicate your participation (Please RSVP for the following meals. Although registration includes all these meals please indicate which meals you will be attending.)
Thursday Welcome Reception @ The Westin
Friday Night Social Event @ The Canadian War Museum
Count me for breakfast:	Fri Sat	Vegetarian meals required
Count me for lunch:	Fri	Vegetarian meals required
Please list any special dietary needs:

3. Indicate Accompanying Person(s)
Print full name of guest(s):
Please indicate your accompanying person(s)' meal participation: $350 Meal Plan: (BEST VALUE): (Includes Welcome Reception, Breakfast & Lunch Friday, Friday Night Social Event and Breakfast Saturday)
Vegetarian meals required	total number x $350
Á la Carte Meal Plan:
Indicate number for Welcome Reception \| Thursday, May 4	total number x $75
Indicate number for Friday Night Social Event \| Friday May 5	total number x $250
Vegetarian meals required
A total will be provided on the next page.
4. Hotel Accommodation All guest room accommodations will be at The Westin Ottawa, 11 Colonel By Drive, Ottawa, ON K1N 9H4 You are responsible for making your own individual reservation by either going to this link Book your group rate for Canadian Brain Tumour Consortium Bi-Annual 2023 or calling reservations at 1.888.627.8528 using the promo code BTC. Preferred Guest Room Rate is $254 per night for either single or double occupancy. See below for further details. A Guest Room Confirmation Number will be sent to you from The Westin Ottawa once your booking is processed. ADDITIONAL DETAILS: Run of house, no bed type guarantee, $254 CAD/night rate is for either single/double occupancy Additional person $40.00 CAD/night Rates do not include applicable provincial and local taxes. Currently taxes are: 13% + 4% municipal accommodation tax (MAT). Taxes and fees are subject to change. The hotel is pet friendly, additional fees may be applied Complimentary access to the Westin Workout facilities Complimentary WIFI Parking rates: 12 hour rate $26.00 CAD/24 hour rate, $30.00 CAD/Valet Parking $48.00 CAD plus tax, per night

You will be given an opportunity to pay for your REGISTRATION FEE(S) ONLY with Paypal on the next page.

Refund Policy: A registration refund will be made upon written request on or prior to April 13, 2023. However, a $30.00 administrative fee will be retained. No refund will be made for cancellations after April 30, 2023. All refunds will be made by check in CND funds after the meeting. Payment Method: a) Credit card via PayPal or b) Cheque must be in Canadian funds payable to: Canadian Brain Tumour Consortium There will be a $50.00 fee charged on cheques returned by the bank due to insufficient funds. Registration confirmation/receipt and further information will be either emailed or mailed.

Payment Method: a) Credit card via PayPal or b) Cheque must be in Canadian funds payable to: Canadian Brain Tumour Consortium There will be a $50.00 fee charged on cheques returned by the bank due to insufficient funds.

Event Contacts
Patty Djan Inc. email 1.416.993.3511	Tatiana Brezden email 1.416.716.1726

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