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Airport/Aerodrome Name: _________________________________ Address:________________________________________________ City: ______________________ Province: _____ Postal: _______ Fax: ___________________________________________________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1st Registrant: Mr. / Ms. / Mrs. __________________________________________ Position: _______________________________________________ Phone: ________________________________________________ E-Mail: ________________________________________________ 2nd Registrant: Mr. / Ms. / Mrs. __________________________________________ Position: _______________________________________________ Phone: ________________________________________________ E-Mail: ________________________________________________ 3rd Registrant: Mr. / Ms. / Mrs. __________________________________________ Position: _______________________________________________ Phone: ________________________________________________ E-Mail: ________________________________________________ 4th Registrant: Mr. / Ms. / Mrs. __________________________________________ Position: _______________________________________________ Phone: ________________________________________________ E-Mail: ________________________________________________ SMS/Human Factors Training Registration Form Payment Method O Please send me an invoice for the total training registration. I will be paying by cheque. O Purchase Order # _____________________________ O Upon receipt of this form, please charge my (Circle one): MasterCard Visa (Cardholder) Name on Card: _____________________________________________________________ Account #: ____________________________________________________ Exp. Date: ____________ Signature: _______________________________ Registration Type No. Price Total Location Member SMS/Human Factors Training– All breaks and lunches included. Course materials included. Certificate of completion will be provided. $750 Sudbury May 8-9, 2018 Sudbury May 8-9, 2018 Non Member SMS/Human Factors Training– All breaks and lunches included. Course materials included. Certificate of completion will be provided. $850 Sub Total Total (Including 13% HST) PLEASE NOTE: Refunds will be given for cancellations until April 6, 2018. No refunds for cancellations will be given after this date. Hotel Accommodations Use the Group Name: AMCC Fairfield Inn & Suites 490 Barrydowne Rd. Sudbury, ON P3A 3T3 Phone: 705-560-0111 Return Registrations To: 5-50 Terminal St. North Bay, ON, P1B 8G2 T: 1-877-636-2626 ext. 200 F: 1-705-474-2379 E: [email protected]
