Meeting Registration Form for Non-members – Canadian Council of University Biology Chairs

Pay by Cheque, PayPal or Credit Card

Please fill in this form along with your CCUBC registration payment for 2024 as instructed on the screen / S'il vous plaît, veuillez compléter ce formulaire et y joindre le paiement de votre inscription au CUDBC pour 2024 en suivant les instructions sur l’ecran.

Please help us keep our mailing list up-dated by informing us of any necessary corrections / S’il vous plaît, aidez nous à garder notre fichier à jour en indiquant les changements vous concernant. Merci!

"*" indicates required fields

University / Université*

Department / Département*

Other Educational Institution*

Contact Information of Chair / Coordonnées du Directeur

Name / Nom*

First Name / Prénom Last Name / Nom de famille

Address / Adresse*

Street / Rue Address more / Adresse enplus City / Ville Province Postal Code / Code Postal

Phone / Téléphone (ext)*

Format: (555) 555-5555 (123)

Email / Courriel*

Enter Email Confirm Email

Meal Choice & Dietary Restrictions

Chicken

Cheddar and watercress stuffed chicken breast with herb bomb, Sweet potato pave and seasonal vegetables

Fish

Cedar baked salmon with juniper and birch syrup glaze, Wild rice pilaf and seasonal vegetables

Beef

Cinnamon and rosemary crusted beef striploin, pan jus, Sweet potato pave and seasonal vegetables

Vegan

Corn and squash chowder served in a cheese gougers

Attendee Main Dish Choice / Choix de plat principal pour le participant

Dietary Restrictions: attendee

GUEST 1 Main Dish Choice / Choix de plat principal pour d'invité 1

Dietary Restrictions: guest 1

GUEST 2 Main Dish Choice / Choix de plat principal pour d'invité 2

Dietary Restrictions: guest 2

GUEST 3 Main Dish Choice / Choix de plat principal pour d'invité 3

Dietary Restrictions: guest 3

Payment Information / Mode de paiement

Enter the number of full-time faculty members in your department /
Notez le nombre de membres de la faculté à temps plein dans votre département

Registration fees, including the banquet / Tarif de registration, inclus le banquet

Price:

Fee for speaker / Tarif pour le conférencier

Price:

Guest banquet tickets / Billets de banquet d'invité

Price:

Number of Guests / Nombre d'invités

Please enter a number from 0 to 3.

Total

Select Payment Method*

If TOTAL is $0.00, please select 'Cheque'

Cheque

Credit Card/PayPal

Please make cheques payable to /
S'il vous plaît, établissez le chèque au nom du:

Canadian Council of University Biology Chairs /
Conseil Universitaire des Directeurs de Biologie du Canada

Send Payment to / Envoyer à:
CCUBC/CUDBC Secretariat
c/o Wafaa H. Antonious
Rofail Conference and Management Services
17 Dossetter Way
Ottawa, Ontario
K1G 4S3

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Payment Received Date

Credit card payments will be processed by PayPal (please note that PayPal accepts VISA and MasterCard).
If you prefer to use your PayPal account, select PayPal Checkout from the payment method dropdown.

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Verify

Annual Meeting

Registration Form for Non-members

Pay by Cheque, PayPal or Credit Card

Contact Information of Chair / Coordonnées du Directeur

Meal Choice & Dietary Restrictions

Chicken

Fish

Beef

Vegan

Payment Information / Mode de paiement

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Additional Resources

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