ACTE: Forum Registration Form



REGISTRATION FORM
Toronto Regional Forum Delta Chelsea Inn October 15, 1997 ACTE Member $100.00* NON-MEMBER, $140.00* Non-Member joining ACTE, $500.00* *Payable in Canadian Dollars Credit card charges will be converted to U.S. Dollars for processing. There will be a small discrepancy in Canadian Dollar billing.
NOTE: This form requests credit card information. If you are not accessing the form via a secure web connection, and your browser supports secure connections, please use this secure version of the form instead.
All fields are required unless marked with a "*".
Name
Title
Company
Address
Address*
City
State/Province
Zip/Postal Code
Country
Telephone
Facsimile
E-Mail*
Registration Fee:
	ACTE Member ($75) Non-Member ($100) Non-Member Joining ACTE ($300)
Payment:
	American Express Diners Club MasterCard Visa
Cardholder Name
Card Number
Expiration Date