CONFERENCE REGISTRATION FORM

All information given below will be kept confidential, all information must be completed.

  You can also download and print the Breast Cancer Conference Offline Registration Form .
Please submit form and registration fee to:

Canadian Cancer Society
70 Ropewalk Lane
PO Box 8921
St. John’s, NL
A1B 3R9


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  Please note, priority is given to first-time registrants and will follow based on number of retreats attended. If number exceed the spaces available, your name may be placed on a waiting list.
   


   


   


  Name:

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Name:

 

 

   

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City/Province/
Postal code:

 

    

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Date of birth

 

What's this?

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Question - Required - I am enclosing a cheque/money order for the $175.00 registration fee. (Please make cheque/money order payable to the Canadian Cancer Society. Do not send cash in the mail.)


 


   


   


  * Payment must accompany your registration form. Please advise ASAP if you wish to cancel, so that someone else may attend in your place. The fee is refundable if you notify us of your cancellation on or before June 5, 2018. Cheques will not be cashed and credit card payments will not be processed until after acceptance is confirmed.
 


 

Health Information:

 

 

 

 

Accommodations and Roommates:

 


  Please check with the roommates you have written down to confirm they have provided your name on their registration form. We will do our very best to accommodate your requests. Jessica from the Canadian Cancer Society will touch base with you on this.
 

  *** To fairly accommodate as many attendees as possible, king and queen beds MUST be shared. In most cases double beds will likely be assigned to one person, however, with a limited number of double beds and many first time participants, we do appreciate your understanding if you must share. Single rooms are not available. You would only share if it is a mutual roommate request. Ask your roommate to write your name on their registration form.
 

Banner of Remembrance:

 

  Please note that our Conference is scent-free. Attendees have suffered serious respiratory problems caused by scents at past Conferences. It is imperative that you do not use body sprays, cologne, perfumes, scented hair sprays, etc. Thank you for your cooperation.

If you have any questions, contact Jessica Cooke at:
Toll Free: 1-888-753-6520 ext. 233 Tel: 709-757-8533 Fax: 709-753-9314 Email: jcooke@nl.cancer.ca
Mail: 70 Ropewalk Lane, PO Box 8921, St. John’s, NL A1B 3R9
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