Register - Saskatoon Sexual Assault & Information Centre

April 23, 2015, TCU Place, Saskatoon
April 24, 2015 – POLICE PERSONNEL ONLY
REGISTRATION FORM
HOW TO REGISTER
By mail:
Telephone:
Fax:
SSAIC, #201, 506-25th Street East, Saskatoon, SK, S7K 4A7
306 244-2294
306 244-6099
Print off a copy of the SSAIC 2015 Conference Registration Form (PDF file) and mail or fax your
completed form, along with payment. Please expect to receive an e-mail confirmation within three to
five business days of receipt of your form. Registration questions may be directed to the SSAIC office
306 244-2294
For agencies with more than one participant, please complete one form for each person; one cheque to
accompany all registrations.
REGISTRATION DEADLINES
Early-bird:
March 31, 2015 (must be postmarked or received by this date)
Regular:
April 13, 2015
(Includes breaks, lunch and conference materials)
Please print:
Name: ______________________________________________________________________________
Organization: ________________________________________________________________________
Address: ____________________________________________________________________________
City: _______________________Province______________________PC_________________________
Telephone: _____________________________Cell/Mobile:___________________________________
Email: ______________________________________________________________________________
REGISTRATION FEES
Thursday, April 23
Student*/Volunteer**
Early Bird (March 31, 2015)
Regular
Late Registration (after April 13, 2015)
________
________
________
________
x
x
x
x
$99
$229
$249
$279
= _______________
= _______________
= _______________
= _______________
□ Visa
□ Mastercard
PAYMENT METHOD:
□ Cash
□ Cheque
Credit Card #______________________________________________________
Security Code (on back of credit card) ______ Expiry Date – Month_____ Year_____
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*student card must be presented at conference
**sexual assault & victim services volunteers
Dietary restrictions:____________________________________________________________
Friday, April 24
POLICE PERSONNEL ONLY
Both days (April 23 & 24)
Friday April 24th only
(Snacks and refreshments provided)
________
________
x $279 = ________________
x $99 = ________________
PAYMENT METHOD:
□ Cash
□
□
□
Cheque
Visa
Mastercard
Credit Card #_______________________________________________________
Security Code (on back of credit card) ______ Expiry Date - Month:_____Year_____
Please make cheques payable to:
Send payment to:
Saskatoon Sexual Assault & Information Centre (SSAIC is OK)
#201, 506-25th Street East, Saskatoon, SK S7K 4A7
ACCESSIBILITY
If you have a disability or condition that requires accommodation to support participating, please
provide details below:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
CANCELLATION POLICY:
Cancellations received on or before March 31, 2015 are entitled to a refund minus a $100 processing
fee. The cancellation request must be received in writing to ssaic@sasktel.net. Cancellations received
after March 31, 2015 will not receive a refund. All refunds will be processed after the conference.
Queries regarding conference registration should be addressed to ssaic@sasktel.net. In the event that
an SSAIC sponsored activity is cancelled, SSAIC cannot be responsible for any cancellation/charge
assessed to registrants by airlines, travel agencies, or hotels.
www.saskatoonsexualassaultcentre/2015conference
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