National Conference General Registration Form

TOURETTE SYNDROME+

Edmonton, Alberta
September 29th – October 1st 2016

PLEASE READ CAREFULLY

Registration deadline is SEPTEMBER 16th, 2016.
Please fill out a separate form for EACH Registrant.

Your registration includes:
• All forum materials, morning and afternoon breaks, and onsite lunch & refreshments.
• Registration will begin at 7:30 am with the program beginning at 9:00 am.

Our Cancellation Policy:
• A $50 administration fee will apply to cancellations from August 19th to September 9th.
• No refunds issued after September 9th, 2016.

BASIC INFO

First Name

Last Name

Address

City

Province

Postal Code

Telephone (required)

Email (required)

Special Dietary Needs (no preferences please)

I will attend the Opening Reception on Thurs. Sep. 29thI will attend the Saturday evening banquet on Oct. 1stI will attend a Meet & Greet group on Thurs. Sep. 29th for:

METHOD OF PAYMENT

Please charge to my:
VisaMasterCardAmex

Credit Card Number

Expiry Date

3 Digit Security Code

Cardholder’s Name

FULL CONFERENCE (includes Saturday banquet)

Early Bird Rate (until September 1st, 2016):
TC Member $320 Non-Member $375

Regular Rate (after September 1st, 2016):
TC Member $350 Non-Member $400

ONE DAY RATE (includes breaks & lunch)

Please check one:
Friday, September 30thSaturday, October 1st

Regular Rate (September 5th to October 7th):
TC Member $165 Non-Member $200

Additional Adult/Youth Banquet Ticket $75

Child Banquet Ticket $30

FULL FAMILY PACKAGE (includes Saturday banquet)

Regular Rate - Save $230 (until September 16th):
TC Members Only $950

SUBTOTAL CONFERENCE FEES

SUBTOTAL CHILD FEES

SUBTOTAL YOUTH FEES

TOTAL PAYMENT