SPE/CSGM Gas Migration Challenges – Identification and Treatment Workshop 13 – 14 May 2015 ● The Rim rock Resort Hotel ● Banff, Alberta, Canada Deadline to Mail/Fax Form 30 April Advanced Registration Form To Receiv e Discounted Rate 15JBAN PARTICIPANT PROFILE Registrant’s Last Name (Family Name) Registrant’s First Name (Forename) Company Name Company Job Title/Position Email Check here if you wish to receive updates via email. Street Address/PO Box Email Type Work Check here if you wish to receive updates via mail. Member Number Home Do you wish to allow your email address and phone number to be distributed to all attendees? Yes No Address type Home Work City State/Province Country Zip/Postal Code Office Telephone (Include country/area/city code) Facsimile (Include country/area/city code) Emergency Contact Name Emergency Contact Telephone (Include country/area/city code) Assistance / Dietary Instruction: Check here if you need special assistance to fully participate. Check here if you have special dietary needs and list requirements. How many years of ex perience do you have in the industry? < 1 year 1-5 years 6-10 years 10+ years REGISTRATION FEES FEE PER PERSON QTY COST REGISTER EARLY AND SAVE By 30 Apr il After 30 Apr il Workshop Registration includes technical sessions, materials, attendee list, continental breakfasts, lunches, coffee breaks, and receptions. $795 $995 SPE Member CSGM Member $995 $1,195 NonMember Committee Member Committee Member Speaker Speaker Additional Ticket Item - Workshop attendees receive complimentary entries to the Networking Receptions. $25 Additional Networking Reception – Monday, 27 April $25 Additional Networking Reception – Tuesday, 28 April Cement Bond Evaluation - Monday, 11 May 2015 Tr aining Cour se $750 $950 SPE Member $950 $1,150 NonMember Cement Remediation – Tuesday, 12 May 2015 Tr aining Cour se $750 $950 SPE Member $950 $1,150 NonMember Tr aining Cour se Bundle Offer Cement Bond Evaluation & Cement Remediation - 11 & 12 May 2015 $1,200 $1,400 SPE Member $1,600 $1,800 NonMember TOTAL CAD ONLINE FAX MAIL TEL EMAIL w ww.spe.org/events/15JBAN/ +1.403.930.5470 (Fax es accepted with credit card payment only. If fax ed, do NOT mail original) SPE Canada 900 – 521 3rd Av e SW Calgary AB T2P 3T3 Canada +1.403.930.5454 Questions ONLY [email protected] PAYMENT OPTIONS All registration fees in Canadian Dollars (CAD) and subject to 5% GST Advance registration requires payment. Forms received without payment will not be processed. Pay ment Enclosed (Make checks payable to: SPE Canada) American Ex press MasterCard Visa (Discover not accepted) Card Number Ex p. Date (mm/yy) Name (As it appears on card) Security Code Total Amount Billing Address (Of card) Signature Date (By typing name and date above you agree to all provisions of this contract) Accommodations are NOT included in the workshop registration fee. Hotel rate w ill be posted on a later date. Please check workshop website for update. WIRE TRANSFER: For payments by wire transfer, email [email protected] and reference the workshop title. Please have your bank include your name and credit 15JBAN Registration. There is limited seating for the training course and registration is not guaranteed until pay ment has been receiv ed. DEADLINE: 30 April 2015 CANCELLATION POLICY: To receiv e a full refund, all cancellations must be receiv ed in writing no later than 30 April 2015. Cancellations made after 30 April 2015 will not be refunded. Send cancellation requests by email to [email protected]; by fax to +1.403.930.5470; or mail to SPE Registration, 900 – 521 3rd Ave SW, Calgary, AB T2P 3T3 Canada