Registration Form - Addictions Ontario

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Oct 29, 2013 (4 years and 14 days ago)

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Name:

Place of Employment:

Address:

City:

Province:

Postal Code:

Telephone:

Email:

Special Dietary Requirements:

Membership:

O
Addictions Ontario


O
Non
-
Member

Community of Practices
(Please indicate what session you will be attending)


O

Residential

O

Youth

O

WMS

O

Community Treatment


O

Business/Infrastructure


Registration Fees:


Member

Non
-
Member


Total


$ 70.00 (two
days)

$ 140.00 (two days)

$ _____________



$ 35.00 (one day)


$

70.00 (one day)

$ _____________



TOTAL:

$ _____________

O
Cheque
(please make payable to Addictions Ontario)

O
Visa

# ___________________________________________ Expiry:
______________

O
MasterCard

# ___________________________________________ Expiry: ______________

Signature: _____________________________________________________________

Light breakfast, lunch and nutritional breaks included for both days.

Location

Meeting Location:



Hotel Accommodations:

Doubletree by Hilton
-

Toronto Airport



Doubletree by Hilton
-

Toronto Airport

655

Dixon Road




655

Dixon Road

Toronto,
Ontario



Toronto, Ontario


A block of rooms is being held for delegates attending the meeting until
WEDNESDAY, NOVEMBER
30TH
. The
preferred rate is $1
29
.00 per night plus taxes.
Parking will not be charged to register
ed guests of the hotel. Unregistered
guests will be charged $12.00 per day.
Please make your reservations by calling
1.800.
668.3656

and refer to
group
code Addictions Ontario
. You may also

copy and paste
the link below to book online
.

http://doubletree.hilton.com/en/dt/groups/personalized/Y/YYZIPDT
-
ADO
-
20111207/index.jhtml?WT.mc_id=POG




Registration Form

Community of Practice Meeting

December 08
t
h
& 09
th
, 2011

Please return completed registration form along with full payment by
WED., NOVEMBER
3
0, 201
1

to:

Addictions Ontario, PO Box 21022, University Mall, Windsor, Ontario, N9B 3T4 or

email to:
info@addictionsontar
io.ca

or


fax to: 1
-
866
-
295
-
6394