CEEPS Registration - one form per person

Canadian Experiential Education Practitioners Symposium - EAST: April 13-15, 2007

[Step 1 - Information]  There are three registration options:  Email, Canada Post, and Fax.  The on-line form below shows all of the information that we require to register you.  If you fill it out on-line using Internet Explorer and click the Submit button, the system will email your registration data to us.

[Step 2 - Payment]  Once the information has been submitted, you can click the link at the end of this form to pay on-line (using PayPal), OR you can mail us a cheque.  Please make your cheque payable to "intellact".   Our mailing address is:

intellact
57 Mary Street
Alton, ON   L7K 0E3

Our fax number is:   (416) 907-2076 (Call ahead first, though!)

If you have a question, our telephone number is:    (416) 907-2076
NOTE that we can not take registrations over the phone - sorry.

STEP 1. Information

Conference Selection *


      April 13-15, 2007
      Bark Lake Leadership Centre
      Irondale, Ontario


Contact Information (* Required fields):

Full Name*
Organization
Title/Occupation

Registration Type *        

Organization Address
City/Town
Org. Province/State
Postal Code
E-mail
Telephone #
FAX #

Personal Address *
City/Town *
Province/State*
Postal Code *
E-mail *
Telephone #
FAX #

Gender * (used for room assignment)        

Conference Fee

= Attendee of any previous CEEPS conference, with fee fully paid or postmarked prior to March 9, 2007.
    $240 + GST = $254.40   No Longer available

= Attendee of any previous CEEPS conference.
    $240 + GST = $256.80   Save over $40!

= Fee fully paid or postmarked prior to March 9, 2007.
    $250 + GST = $265.00   No Longer available

= Attendee from outside Ontario.
    $190 + GST = $181.90   Save over $110!

= Attendee from U.S. and other countries.
    $170 USD   Save over $100 USD!


    $300 + GST = $318.00

= Attendee under 25 years of age.
    $210 + GST = $222.60   Save over $90!

The full fee is payable by PayPal (click the link at the end of this registration form), or by cheque, mailed to the address shown above.  Note that PayPal accepts credit cards and other forms of payment.  If you are paying by cheque, you must make your cheque payable to "intellact".

Meals & Accommodation

The conference fee includes meals and accommodations (double rooms - hotel style) from Friday dinner to Sunday lunch.  If you do not require a room or cannot stay for the full conference, please contact us for special arrangements.

Do you have any special dietary needs?  Please specify:

Are you attending with a colleague that you will be sharing a room with?

If so, please give their name:  

I'd rather pay a small premium and have a room to myself:

If not, please help us make a good match for your double accommodation by telling us about YOU:

Age range:      
 
   

Workshop Information

If you have a workshop topic, or would like to see a session/discussion on a particular topic, or can tell us what you hope to get out of this symposium, this is the place to write it *:


(* The above is a required field)

Is there anything else we should know or that you would like to ask?

NOTE: Clicking the "Submit Registration" button in Internet Explorer should create an email which will be placed in your normal email Outbox.  (The software seems to have a preference for MS Outlook/Outlook Express.)  Please note that your registration is not complete until your fee is received by mail.

You should get a number of messages after clicking "Submit Registration".  If you do not, OR if you don't hear back from us within 2 days, then assume we did NOT get your registration, and call or email us directly.


STEP 2. Payment

Once the above information has been submitted, you can click here to pay on-line using PayPal (which accepts credit cards, etc.),

OR you can mail us a cheque.  Please make your cheque payable to "intellact".   Our mailing address is:

intellact
57 Mary Street
Alton, ON   L7K 0E3

Our fax number is:   (416) 907-2076 (Call ahead first, though!)

If you have a question, our telephone number is:    (416) 907-2076
NOTE that we can not take credit card payments over the phone - sorry.

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