Page 1 of 2 Delegate Registration Form Online registration www.cpma.ca 90th Annual Convention and Trade Show April 15-17, 2015 – Montréal, QC, Canada It’s quick and easy! Telephone: (+1) 613-226-4187 • Fax: (+1) 613-226-2984 • [email protected] Full delegates will have access to all business and social events including meal functions, as well as access to the trade show. More information on the event can be found at www.cpma.ca. STEP 1 · Delegate Information Receive reduced registration prices when you register on or before February 20, 2015. Please type or print clearly – one person or couple per form. Your name and company will appear on your badge exactly as you indicate below. Where space is limited, abbreviations may be used (i.e. company name). Mr Mrs Language of correspondence: Ms First Name English French Last Name Title Company Street Address City Prov./State Telephone Postal/Zip Code Country Ext. Cellular Email (email is required to receive electronic confirmation) Website Please indicate if you have any food allergies/restrictions? In case of an emergency, please contact: Yes No Specify: Name Relation Telephone STEP 2 · Company Business Type Please check one. 1. Retailer 4. Grower/Shipper 7. Processor 2. Wholesaler 5. Broker 8. Media 3. Foodservice Operator/Distributor 6. Industry Supplier 9. Service Provider 10. Importer/Exporter STEP 3 · Spouse/Companion Program Please type or print clearly. Complete this section ONLY if you are registering for the spouse/companion program. See registration fees on next page. A spouse/ companion registration must be accompanied by a Full delegate registration and is intended for the delegate’s spouse or significant other only and not for additional corporate registration. Mr Mrs Ms First Name Last Name Email Please indicate if you have any food allergies/restrictions? In case of an emergency, please contact: Name Yes No Specify: Relation Telephone Delegate Registration Form Page 2 of 2 STEP 4 · Registration Fees HST/GST #106846587 RT0001 Please check appropriate boxes All delegates - excluding Quebec residents QST #1015654194 CPMA MEMBER Base 5% GST NON-MEMBER Total Base 5% GST Total Early Bird - BY February 20, 2015 Qty Business Delegate $900.00 $45.00 $945.00 $1,250.00 $62.50 $1,312.50 Companion/Spouse $525.00 $26.25 $551.25 $700.00 $35.00 $735.00 $50.00 $2.50 $52.50 $150.00 $7.50 $157.50 $1,075.00 $53.75 $1,128.75 $1,450.00 $72.50 $1,522.50 $625.00 $31.25 $656.25 $800.00 $40.00 $840.00 $50.00 $2.50 $52.50 $150.00 $7.50 $157.50 Retail Tour Total Regular - AFTER February 20, 2015 Business Delegate Companion/Spouse Retail Tour GRAND TOTAL Delegates - Quebec residents CPMA MEMBER Base 9.975% QST 5% GST NON-MEMBER Total Base 5% GST 9.975% QST Total Early Bird - BY February 20, 2015 Qty Business Delegate $900.00 $45.00 $89.78 $1,034.78 $1,250.00 $62.50 $124.69 $1,437.19 Companion/Spouse $525.00 $26.25 $52.37 $603.62 $700.00 $35.00 $69.83 $804.83 $50.00 $2.50 $4.99 $57.49 $150.00 $7.50 $14.96 $172.46 $1,075.00 $53.75 $107.23 $1,235.98 $1,450.00 $72.50 $144.64 $1,667.14 $625.00 $31.25 $62.34 $718.59 $800.00 $40.00 $79.80 $919.80 $50.00 $2.50 $4.99 $57.49 $150.00 $7.50 $14.96 Retail Tour Total Regular - AFTER February 20, 2015 Business Delegate Companion/Spouse Retail Tour $172.46 GRAND TOTAL STEP 5 · Method of Payment Please type or print clearly – no invoices will be issued. Pay by cheque or credit card. Visa American Express MasterCard Cheque enclosed (Make cheque payable to: Canadian Produce Marketing Association) Credit Card Number CVV (3 or 4 digit code on back of credit card) Expiry Date m m Cardholder’s Name Signature Note: Credit card information provided here is for registration fee payment only. Date Cancellation Policy: All requests for cancellation must be in writing. There is a $150.00 processing fee per registrant for cancellations received on or before February 27, 2015. No refunds will be issued after February 27, 2015. STEP 6 · Send in Your Registration Fax or email all pages (credit card payment only) to: (+1) 613-226-2984 or [email protected] Or mail (with payment) to: Canadian Produce Marketing Association 162 Cleopatra Drive, Ottawa, Ontario, Canada K2G 5X2 Privacy Policy: By completing this form you consent to the use of the personal information you provided for registration and marketing purposes. For more information regarding CPMA’s Privacy Policy, please visit our website at www.cpma.ca For CPMA Use Only y y Page 1 of 2 Partial Registration Form Canadian Produce Marketing Association • 90th Annual Convention and Trade Show April 15-17, 2015 – Montréal, QC, Canada Telephone: (+1) 613-226-4187 • Fax: (+1) 613-226-2984 • [email protected] Online registration • www.cpma.ca • It’s quick and easy! STEP 1 · Delegate Information Please type or print clearly – one person or couple per form. Your name and company will appear on your badge exactly as you indicate below. Where space is limited, abbreviations may be used (i.e. company name). Mr Mrs Language of correspondence: Ms First Name English French Last Name Title Company Street Address City Prov./State Postal/Zip Code Telephone Ext. Country Cellular Email (email is required to receive electronic confirmation) Website Please indicate if you have any food allergies/restrictions? Yes Specify: No In case of an emergency, please contact: Name Relation Telephone STEP 2 · Company Business Type Please check one. 1. Retailer 6. Industry Supplier 2. Wholesaler 7. Processor 3. Foodservice Operator/Distributor 8. Media 4. Grower/Shipper 9. Service Provider 5. Broker 10. Importer/Exporter Partial Registration Form Page 2 of 2 STEP 3 · Registration Fees HST/GST #106846587 RT0001 Please check appropriate boxes All delegates - excluding Quebec residents QST #1015654194 CPMA MEMBER Base 5% GST NON-MEMBER Total Base 5% GST Total Wednesday April 15, 2015 Qty $50.00 $2.50 $52.50 $150.00 $7.50 $157.50 $150.00 $7.50 $157.50 $180.00 $9.00 $189.00 Day Pass* $410.00 $20.50 $430.50 $495.00 $24.75 $519.75 After Party $25.00 $1.25 $26.25 $35.00 $1.75 $36.75 Banquet Ticket (Single ticket) $180.00 $9.00 $189.00 $225.00 $11.25 $235.25 Banquet Table (Table of 10) $1,620.00 $81.00 $1.701.00 $2,025.00 $101.25 $2,126.25 $10.00 $210.00 $200.00 $10.00 $210.00 Retail Tour Welcome Reception Total Thursday April 16, 2015 Friday April 17, 2015 Thursday April 16 & Friday April 17, 2015 Trade Show only $200.00 GRAND TOTAL Delegates - Quebec residents CPMA MEMBER Base 5% GST 9.975% QST NON-MEMBER Total Base 5% GST 9.975% QST Total Wednesday April 15, 2015 Retail Tour Qty $50.00 $2.50 $4.99 $57.49 $150.00 $7.50 $14.96 $172.46 $150.00 $7.50 $14.96 $172.46 $180.00 $9.00 $17.96 $206.96 Day Pass* $410.00 $20.50 $40.90 $471.40 $495.00 $24.75 $49.38 $569.13 After Party $25.00 $1.25 $2.49 $28.74 $35.00 $1.75 $3.49 $40.24 Welcome Reception Total Thursday April 16, 2015 Friday April 17, 2015 $180.00 $9.00 $17.96 $206.96 $225.00 $11.25 $22.44 $258.69 Banquet Table (Table of 10) $1,620.00 Banquet Ticket (Single ticket) $81.00 $161.60 $1,862.60 $2,025.00 $101.25 $201.99 $2,328.24 $19.95 $229.95 $200.00 $10.00 $19.95 $229.95 Thursday April 16 & Friday April 17, 2015 Trade Show only $200.00 $10.00 GRAND TOTAL *Thursday Day Pass: Includes Delegate & Companion Breakfast, Business Sessions, Delegates Lunch, Trade Show & After Party. STEP 4 · Method of Payment Please type or print clearly – no invoices will be issued. Pay by cheque or credit card. Visa American Express MasterCard Cheque enclosed (Make cheque payable to: Canadian Produce Marketing Association) Credit Card Number CVV (3 or 4 digit code on back of credit card) Expiry Date m m Cardholder’s Name Signature Note: Credit card information provided here is for registration fee payment only. Date Cancellation Policy: No refunds. STEP 5 · Send in Your Registration Fax or email all pages (credit card payment only) to: (+1) 613-226-2984 or [email protected] Or mail (with payment) to: Canadian Produce Marketing Association 162 Cleopatra Drive, Ottawa, Ontario, Canada K2G 5X2 Privacy Policy: By completing this form you consent to the use of the personal information you provided for registration and marketing purposes. For more information regarding CPMA’s Privacy Policy, please visit our website at www.cpma.ca For CPMA Use Only y y
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