DMA CSD & AGM
2000
Attendance Registration

PLEASE NOTE:
This is not a Hotel registration,
you should contact the Hotel directly

Hampton Inn,
100 Coventry Road,
Ottawa,

Phone 1-800 HAMPTON (426-7886)
or locally 741 2300,

e-mail [email protected]

Name: Rank: Active/Retired:
ActiveRetiredNon

Street Address:

City: Prov/State: Post/Zip Code:

Telephone: Fax: Email:

(Please format telephone number as above, and delete format example text before entering information)

DMA Branch or CFMS Unit:

Expected Arrival Date: Departure Date:

Conference Status:AGM Status:

Registration Options: Complete Packages

(INCLUDES: DMA Clinical Study Day & AGM, Meet & Greet Reception, Mess Dinner)
DMA Members - $135.00
CFMS Personnel - $135.00
Other CF Military Personnel - $135.00
Others & Civilian Personnel Attending - $135.00

Other Options:

Clinical Study Day Only
DMA Members - $80.00
CFMS Personnel - $80.00
Other CF Military Personnel - $80.00
Civilian Personnel Attending - $80.00

AGM
DMA AGM Only No Cost

Mess Dinner
(Note: One Mess Dinner ticket is included in the Complete Package. Additional tickets
must be purchased for guests. Those not attending for the complete package must purchase
their own tickets.)

Just the One Mess Dinner Ticket - Included in my Complete Package.
One Extra Mess Dinner Ticket - $55.00
Mess Dinner Guest (limit one) as there are only 120 seat places available!

***SPECIAL MENU: Please indicate if you have a special food requirement for the Mess Dinner.
Any Questions:

Note 1: Remember to include you e-mail address so that we can acknowledge that you registration was received!

Note 2: Program and costs are subject to changes.

Date of Registration:

PLEASE NOTE:

You can either:
1. Fill out the form above on-line, click on "Apply" below and mail your cheque or money order to:

- OR -
2. Print out this form, fill it out and mail a paper copy with your cheque or money order to:
DMA CSD & AGM 2000
Defence Medical Association of Canada
Major (ret'd) A.C. King
990 Cromwell Drive,
OTTAWA, ON K1V 6K6
Phone: (613) 733-2079 or e-mail: [email protected]

NOTE:
Please return your registration form with a cheque or
money order payable to
Defence MedicalAssociation - AGM 2000
to be received no later than 01 Oct 00

Your registration application will not be confirmed until either a cheque or money order has been received by DMA!

The College of Physicians and Surgeons
has granted
"5 MAINPRO M1 credits"
for the
DMA CSD

DMA AGM&CSD 2000
Sponosorship by:

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Name:	Rank:	Active/Retired: ActiveRetiredNon
Street Address:
City:	Prov/State:	Post/Zip Code:
Telephone:	Fax:	Email:
(Please format telephone number as above, and delete format example text before entering information)
DMA Branch or CFMS Unit:
Expected Arrival Date:	Departure Date:

DMA CSD & AGM 2000 Attendance Registration

Registration Options: Complete Packages

(INCLUDES: DMA Clinical Study Day & AGM, Meet & Greet Reception, Mess Dinner)

Other Options:

Clinical Study Day Only

AGM

Mess Dinner

PLEASE NOTE:

DMA CSD & AGM
2000
Attendance Registration