Water Registration Form

    How Blue is Your Bottom Line?     Toronto, September 18-19, 2012  Name: ______________________________________________________________________ Title/Company: _______________________________________________________________ Address: __________________________________________Postal Code: ________________ Email Address: ________________________________________________________________ Phone: ______________________________________________________________________  Fees: Regular Price:  $999 + 13% HST ($129.87) = $1128.87  *15% Discount:  Early Registration Discount until August 1st    $849.15 + 13% HST ($110.39) = $959.54  Total Due: $ ____________ (Please enter the full price +HST as above)  HST Exemption Number: ___________________________  ? Price includes light breakfast, lunch, networking reception and course material. A Certificate of Completion will be issued at the end of the course.  Where did you hear about this course:  _______________________________________  Payment:  ? Visa/Amex/MasterCard (Please circle one)   Number___________________________________________________ Expiry Date______________  Signature: _______________________________________________________   PLEASE FAX, MAIL or EMAIL IN YOUR COMPLETED FORM:   University of Toronto, Centre for Environment Professional Development Programs 33 Willcocks Street, Room 1016V Toronto, ON M5S 3E8  FAX: 416.978.3884 EMAIL: d.workman@utoronto.caA Certificate of Completion from the University of Toronto is issued on completion of this course. Certificates may be used to qualify for eligibility for Continuing Education Credits from professional associations. Please contact your association to confirm its requirements.