REGISTRATION FORM First Name: Last Name: Organization: E-mail Address: Mailing Address: Position: Phone Number: City: Province: Postal Code: Are you a member of the OGA Yes ______ No _______ If No, would you like to receive information about joining the OGA, subscribing to our newsletter and benefiting from Member discounts, including saving on this Conference Registration Fee? For more information or to join today, click here. SESSION REGISTRATION Please indicate the presentations/workshops you wish to attend. Session information will be added as it becomes available. Session A: (10:15 am – 11:15 am) □ A1 □ A2 □ A3 □ A4 □ A5 □ A6 Session B: □ B1 □ B2 □ B3 □ B4 □ B5 □ B6 □ C1 □ C2 □ C3 □ C4 □ C5 □ C6 (11:30 am – 12:30 pm) Session C: (1:30 pm – 2:30 pm) Please indicate any dietary restrictions:______________________________________________________ PAYMENT: Payment Method: Cheque/Money Order Visa MasterCard Cardholder’s Name: ______________________________ Card Number: __________________________ Exp date:___/_______ Signature:_________________________________________________ Charitable Registration No. 119248698 Conference Registration Options & Fees Full Conference Tuesday, April 21st and Wednesday April 22nd, 2015: Includes scheduled sessions for both days, access to Exhibitors Hall/Trade Show as well as Tuesday evenings Keynote Speaker, OGA Positive Aging Award Dinner/ Reception as well as Continental Breakfast, Lunch and Nutrition breaks on both days. OR RGPs of Ontario Education Day Tuesday April 21st, 2015 (8 – 4 pm): Includes scheduled sessions for the day and access to Exhibitors Hall/Trade Show. Meals include a Continental Breakfast, Lunch and Nutrition breaks. OR Tuesday Evening Events April 21st (4pm – 9pm): Includes Positive Aging Award Presentation, Plenary Session and special dinner Conference Pricing Early Bird Pricing Up to and Including March 16, 2015 Full Conference Plus HST Total Full Conference Plus HST Regular Pricing After March 16, 2015 Full Conference Plus HST Total Full Conference Plus HST OGA Members: Regular $349.00 $45.37 $394.37 $425.00 $55.25 $480.25 OGA Members: Senior/Student $175.00 $22.75 $197.75 $210.00 $27.30 $237.30 Non Members: Regular $396.00 $51.48 $447.48 $495.00 $64.35 $559.35 Non Members: Senior Student $220.00 $28.60 $248.60 $247.00 $32.11 $279.11 RGP Day Only April 21st - Does not include Dinner. $150.00 $19.50 $169.50 $175.00 $22.75 $197.75 Tuesday Evening Dinner Only $75.00 $ 9.75 $84.75 2 Please MAIL your completed Registration Form and Cheque payable to: Ontario Gerontology Association 90 Eglinton Avenue East, Suite 601 Toronto, ON M4P 2Y3 OR Scan your Registration Form and email to: [email protected] Hotel Information: Refund Policy: Cancellations received in writing will be accepted up to March 3rd, and payment will be refunded less an administration fee of $60.00. Cancellations received after that date will not be refunded, however delegate substitutions will be accepted. ADDITIONAL INFORMATION The Conference will be held at the International Plaza Toronto Airport, 655 Dixon Road, Toronto, Ontario. Phone: 416-244-1711 or 1- 800-668-3656. Guest rooms are available at a Special Conference rate, on a first come first served basis. Please contact the hotel directly to book at http://www.internationalplazahotel.com Parking: Parking is available on-site for a fee and payable to the Hotel. Driving Directions: http://www.internationalplazahotel.com/directions From QEW: HWY 427 north, exit Dixon Road east (Hotel is on the right hand side). From Hwy 401 East: Take Dixon Road exit, turn left at the lights (west onto Dixon Rd) Hotel is on the left hand side a couple of minutes down the road at Kelfield and Dixon. From HWY 400: Take 400 South, 401 west, take Dixon Road/Martingrove exit, exit on Dixon Road, the Hotel is on the left hand side, at the first set of lights. Continuing Education Credits: A Certificate of Attendance will be issued to all participants and may be used to obtain Continuing Education Credits. 3 Is committed to working with all stakeholders to improve the quality of life for older adults by advancing the teaching, learning and practice of Gerontology in the province. OGA is an Associate of the Canadian Association on Gerontology. OGA Administrative Office 90 Eglinton Avenue East, Suite 601 Toronto, ON M6G 3C3 Tel: 416-535-6034 Fax: 416-535-6907 Email [email protected] Web: www.ontariogerontolgy.ca Regional Geriatric Programs of Ontario Provide a comprehensive network of specialized geriatric services, which assess and treat functional, medical and psychosocial aspects of illness and disability in older adults who have multiple and complex needs. Working in collaboration with primary care physicians, community health professionals and others, we seek to meet the needs of the most frail and vulnerable seniors. In 1986, RGPs were established at Academic Health Sciences Centres in Hamilton, Kingston, London, Ottawa and Toronto and together form the Ontario Provincial Network of Regional Geriatric Programs. RGPs of Ontario Administrative Office Marlene Awad Email: [email protected] Phone: 416-480-6100 Ext: 3341 Fax: 416-480-6068 Web: www.rgps.on.ca 4
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