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Title *
First Name *
Last Name *
Institution/Organization
Address Line 1 *
Address Line 2
City *
Province/State *
Postal/Zip Code *
Country *
Telephone *
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I am a:
I would like to purchase ticket(s) at $194.25 a piece.
I would like to purchase ticket(s) at $162.75 a piece.
Total registration cost:
Please note that all fees are in Canadian (CDN) funds and include 5% GST. Wire transfers are subject to an additional $17.50 handling fee.
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