Ontario Course Registraton Form  
(not required for Breakfasts)

Company Contact Info:

Company:

Address:

City:

Province:  

Postal Code:

Admin Contact:

Contact :

Title:  

Email:  

 

Phone:

Fax:  

Cell:  


Person A:

Name A

Title

Email:

Dietary Restrictions

Course

Date

Location

Course Fee

  

 

Person B:

Name B

Title

Email:

Dietary Restrictions

Course

Date

Location

Course Fee

  

 

Person C:

Name C

Title

Email:

Dietary Restrictions

Course

Date

Location

Course Fee

  

 



Comments:

If you are registering more than 3 people, please give us a call or use the comment box for further information.

Payment:

Please select cheque or credit card payment. If you select credit card, we will contact you for the credit card information. Cheque VISA MasterCard

If you are GST Exempt, please check the box below and fill in your GST Exempt number:

GST Exempt

GST Exempt Number:


Person

 Course Fee

 

GST

  

Total Fee

 

"A"

$

+

$

=

$

 

"B"

$

+

$

=

$

 

"C"

$

+

$

=

$

 
Total Payment:
 
$
 

If paying by cheque, please make cheque for $ payable to "Pinchin Environmental Ltd. Thank you.

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Hazardous Materials
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