Secure EPIC Registration

National Elder Planning Issues Conference

Your Name - CIPR # (if applicable)

Are you an EPC Member? Yes No

Your Information:

Company Name:

Street:

City:

Province:

Postal Code:

Business Phone: Ext:

Home Phone:

Cell Phone:

Fax:

Email Address:

If you are registering for your spouse, please fill in this information.

Spouse's Name - For name badge:

Email Address:

If you are registering for a guest, please fill in this information.

1st Guest Name - For name badge:

Email Address:

2nd Guest Name - For name badge:

Email Address:

I am registering for:

Questions? Type anything you have a question about here and we will get back to you.

____________________________________________________________________________________________________________________

Your CONFERENCE FEE to attend the Niagara Falls, ON conference LIVE IN-PERSON

* EPC Member Fee - $429.00 + Tax

* Non-Members - $529.00 + Tax *

Spouses - $229.00 + Tax - No CE Credits

Your CONFERENCE FEE to attend the Niagara Falls, ON conference LIVE WEBINAR PRESENTATIONS. All times are Ontario local times.

* EPC Member Fee - $349.00 + Tax

* Non-Members - $399.00 + Tax ____________________________________________________________________________________________________________________

Please also note – If you cancel your registration for any reason WITHIN 14 days of the conference, there ARE NO CASH REFUNDS. We will keep a credit on file for you to use in the future. This is necessary as the conference Food and Beveridge requirements have already been ordered for you and cannot be changed.

Payment Method

For Credit Card Payment's we accept the following cards

Visa

MasterCard

Card Number: Expiry Date

* EXAMPLE - 5555 4444 3333 2222 (please leave space between each four numbers)

CVV2# (3 Digit Code on the back of your Credit Card)

Name on card:

I will send an E-Transfer Please send E-Tranfers to: payments@cieps.com (No Password is Required)

For Payments made by Cheque
Make checks payable to - Canadian Initiative for Elder Planning Studies

I will Mail my Cheque

Mail your cheque to -

Canadian Initiative for Elder Planning Studies
Suite 203, 4438 Ontario Street
Beamsville, ON
L3J 0A4

Type 1234 in the box to the right then click Submit Form:

Canadian Initiative for Elder Planning Studies Inc.
203-4438 Ontario Street

Beamsville, ON L3J 0A4

Toll Free Phone 855 882-3427 & Fax 866 209-5111