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CFMS OPMED 99
with
DMA CSD & AGM
Attendance Registration

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

HOTEL LOEWS LE CONCORDE
1225 Place Montcalm
������ Quebec City, Canada
������ G1R 4W6

������ Telephone: (418) 647-2222, (800) 463-5256
������ Facsimile: (418) 647-4710
������ Telex: 0513959


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: OPMED 99, DMA Clinical Study Day & AGM, Meet & Greet Reception, Mess Dinner)

DMA Members - $160.00
CFMS Personnel - $190.00
Other CF Military Personnel - $230.00
Others & Civilian Personnel Attending - $385.00


Other Options:

OPMED 99 Only

DMA Members, CFMS Personnel, and Other CF Military Personnel - $20.00 Coffee, etc.
Others & Civilian Personnel Attending - $275.00

Clinical Study Day Only

DMA Members - $60.00
CFMS Personnel - $80.00
Other CF Military Personnel - $130.00
Civilian Personnel Attending - $130.00


AGM

DMA AGM Coffee, etc. - $10.00

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 Mess Dinner Ticket - $70.00
Two Mess Dinner Tickets - $140.00

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:

OPMED 99 with DMA CSD & AGM
Defence Medical Association of Canada
Post Office Box 538
Orleans ON
K1C 1S9

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


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