Non-Member Registration with Passport

Print Form
2016/17 Non-Member PASSPORT Registration Form
(Passport Expires March 31, 2017)
DEADLINE FOR PASSPORT PURCHASES - Oct 14, 2016
Course Registration Deadlines: 2 weeks prior to all course dates and
Oct 14th for any Halifax PD Week courses
On-line Registrations at www.cpans.ca
Individual Passport Registrant or Contact Info for "Organizer" of Organization Passport
Designation/s
Name
Company/ Firm
Address
Province
City
Postal Code
Telephone
Fax
Email
CPA Nova Scotia Member: If any of the above info is new please click here so we can update our members database
FEES
Individual PD Passport
($760 member pricing [CPAs]
or $945 non-member) (5 full days)
$
($2,530 for member pricing [for CPAs]
Organization PD Passport
or $2,915 to include non-members) (9 full days)
Additional Courses
(see reverse)
$
$
Late Registration Fee - $30 per course $
Subtotal
$
HST 15% $
TOTAL FEE $
Registrations without payment will not be processed. Complete
and mail this form, along with a cheque payable to the CPA Nova
Scotia, or fax with Credit Card information to:
Contacts:
VISA
MasterCard
Cheque Enclosed
Credit Card Information:
Name
CPA NS PD Department
300 - 1871 Hollis Street
Halifax NS B3J 0C3
Phone: 902-425-7273
Payment Method:
Card #
Fax: 902-407-2967
Kathie Slaunwhite, PD Director
kslaunwhite@cpans.ca
Cindy Mombourquette
cmombourquette@cpans.ca
Expiry Date
V-Code:
Signature
HST # 809535321 RT0001
Receipts are available only upon request (cmombourquette@cpans.ca )
INSTRUCTIONS FOR FILING
Individual Passports
This registration form must be accompanied by a completed worksheet indicating courses etc. (see reverse for worksheet)
Organization Passports
Only one copy of this side of the registration form should be submitted for each passport, accompanied with a
completed worksheet for each registrant who is included in the organization passport (see reverse for worksheet)
Please note:
NO REFUND will be made for passport cancellations received after the Passport deadline date. Refunds for withdrawals before that date will be
subject to a handling charge of $30 plus HST per course.
CPA NS PASSPORT REGISTRATION WORKSHEET
A separate worksheet to be completed and submitted for each passport participant
(Additional worksheets can be photocopied or downloaded from our PD section on our website: www.cpans.ca)
Member ID
Name of Participant
Professional
Designation/s
Email
Phone
Courses included in the Passport:
Course#
Passport credits
(Full day = 1 Credit)
Date
Course Title
Total Credits
(Maximum: Individual Passport = 5 full days; Organization = 9 full days - see note below)
days
Note for Organization Passport holders: This side of the form must be completed and submitted for each registrant in the passport together with the reverse side to be
completed with the contact info for the "organizer" of the Organization Passport. Please be sure that the total of all courses selected by all participants does not exceed 9 full
days. Courses in excess of this amount can be included as additional courses in the section below.
Additional Courses:
Course#
Date
Course Title
Cost
$
$
$
$
$
$
Total (Transfer to front page)
$
Passport Pricing Information for your Convenience
"Member" passport holders can register for additional PD Passport Valid courses in excess of the passport entitlement at the per course passport cost. The
following table shows a breakdown of the Passport pricing. Please refer to your PD Brochure or www.cpans.ca for full rules and regulations:
PD Passport Fees
PASSPORT TYPE
DAYS
Member
Pricing
Individual
5 full/ 10 half
$760
Organization Member
9 full/ 18 half
$2,530
Organization Non-Member
9 full/ 18 half
Non Member
$945
$2,915
Additional Per Course Fee
Member Pricing
Non-Member
Full
Half
Full
Half
$220
$115
N/A
N/A
$220
$115
N/A
N/A
$220
$115
N/A
N/A
Questions? Call Kathie or Cindy @ 902-425-7273