National Culture of Peace/Canadian Peace Initiative Symposium
NOVEMBER 21 - 23, 2004, at McMASTER UNIVERSITY IN HAMILTON, ONTARIO, CANADA
First name:__________________________________ Surname:__________________________________
Organization:____________________________________________________________________________
Address:________________________________________________________________________________
City:__________________________________ Prov./State:___________________ Postal code/Zip:______________
Phone:________________________________________ Fax:_____________________________________
Email:_________________________________________ Website:_________________________________
Dietary/Special Needs:_____________________________________________________________________
I wish to participate in the
following (please check all that apply):
Earlybird Fee
Registration
Amount
Check
Event
Prior to Oct. 31 After Nov.
1
Payable
$
_____ National Culture of Peace Program/CPI
Symposium
Full:
$200
Full: $250
Sunday Nov. 21 to
Tuesday Nov. 23
Student:
25
Student: 50
Retiree:
50
Retiree:
75
_______
TOTAL PAYABLE:
$ _______
Payment Method:
_____ Cheque (made payable to Canadian Centres for Teaching Peace _____ Money Order
_____ Visa _____ Mastercard Cardholder's Name________________________________
Card Number:_________________________________ Expiry Date:_____________________
Please mail or fax form with payment to:
Robert Stewart, Canadian Centres
for Teaching Peace
Box 70, Okotoks, AB, Canada T1S 1A4
Tel: 1-403-938-5335 Fax:
1-403-938-4117
Cancellations are allowed up to November 10 with a 15% cancellation fee. Though refunds are not possible for cancellations after November 10, registrants unable to attend can assign their participation to someone else. All amounts above in Canadian dollars. If paying in U.S. dollars, multiply by .8
Registration fees are intended to cover conference costs. Any surplus will be contributed to the Canadian Peace Education Foundation (ref. http://www.peace.ca/foundation.htm )