EmailMe Form - AGM Registration Form

Date *

MM / DD / YYYY

Last Name *

Given Names *

Telephone *

### - ### - ####

Email *

Number of guest(s) attending *

Members Name

Members meal choice

Name of guest #1

Guest #1 meal choice

Name of guest #2

Guest #2 meal choice

Name of guest #3

Guest #3 meal choice

Name of guest #4

Guest #4 meal choice

Name of guest #5

Guest #5 meal choice

Please note any dietary restrictions:

FEES

Board meeting - $20.00 per person
Dinner/Awards - $90.00 per person
Dinner/Awards fees are complimentary for new Fellows and one guest (if more than one guest, please submit appropriate payment).

Payment Method *

To pay by credit card, click on the link provided on the confirmation page which appears after you SUBMIT your application.

If you wish to make other registration/payment arrangements contact the office: The Canadian Society of Senior Engineers 464 Briar Avenue, Ottawa, Ontario, K1H 5H6 or SECRETARY – Margaret Kuzyk E-mail: info@seniorengineers.ca

2018 Fellow Awardee.

Total amount of payment *

Example: 2 guests for both events = $220.00.