Symposium 2009 Registration Form

THIS FORM HAS BEEN DISABLED UNTIL REGISTRATIONS ARE UP FOR 2010.  IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT SAFETY SERVICES NEW BRUNSWICK AT 1-877-762-7233.  

Making Safety a Way of Life - At Work. At Home. At Play

Name:
Title:
Company:
Are you a Safety Council Member? Yes No
Address:
Address(2):
City:
Province:
Postal Code:
Tel:
Fax:
Email Address:
(confirmation will be sent via email)
Please indicate which sessions you plan to attend. 
(note: not all sessions have more than 1 option)
Payment Method Visa
Mastercard
American Express
Invoice Me
We will contact you regarding Payment. Payment is due before Symposium
Price to Attend NBSC Member $250 (contact the Council if you are unsure of membership)
Non-Member $350
Additional Meal Tickets
(for spouse or guest)		 Buffet Lunch $20 (HST included)
Banquet Dinner $40 (HST included)		 Please note: 1 Buffet and 1 Banquet ticket is included with your registration
For Hotel Reservations:

Please contact the Delta Brunswick Hotel at 1-800-335-8233
Quote Reference: NBSC Symposium
*Due to unforseen demands for hotel rooms during these dates, space will be limited. Book early to avoid disappointment.