Dental Conference Registration Canada Cardp 2016 Members Dental Conference Registration 1 12 23 1 Attendee Information PrefixDr.Mr.Mrs.Ms.First Name*Last Name*Email* Phone*Pay Dues: Select Your Membership Category TypePay Dues*CARDP Member Dues PaidActive/Fellow Member - $600Life MemberHonorary MemberMilitary Member - $325Full Time Faculty Member - $325Technician Member - $4752nd Year Dentist Member - $300Attending Meeting Conference?*Yes ConferenceNo ConferenceConference Attendance Categories*PLEASE SELECT CATEGORY. --Active/Fellow Member Conference Fee - $375Life Members - $ 375Honorary Member - $ 0.00Technician MemberFull Time Faculty MemberMilitary MemberTotal $ 0.00 CAD 2 Select Your Conference Activity Options SOLD OUT - Thursday, September 8 - Hands On Course - Dr. Tim Hempton - Crown Lengthening; Functional and Esthetic7 CE Credits Issued - Marriott Halifax Harbourfront Hotel "Acadia" Ballroom ($ 495.00 Space is Limited)Attend -- Hands On Course - Full Day, Thursday, September 8N/ASame guest for all selected activities? Yes - same guest Guest Name(s) for ActivitiesNames separated by commaKayaking with the Shaffner's in Lunenburg - Wednesday & Thursday September 7 & 8 Guests to make their own way to Lunenburg.For registrants and/or guests. Inclusive of Accommodations based on double occupancy. Welcome evening Dinner, Breakfast, Kayaking and snacks and meals all Taxes and Gratuities. Price: $ 335.00 CAD Quantity: Guest Name(s) for ActivitiesNames separated by commaGolf at the Chester Golf and Country Club - Thursday September 8 (6:45 am - 3:00 pm)For registrants and/or guests. Inclusive of Green Fees, Carts, Luncheon, Transfers, Taxes and Gratuities. Transfer Departing 7:00 am - Halifax Marriott Harbourfront Hotel (Meet in the Lobby 6:45 am) Price: $ 185.00 CAD QuantityGuest Name(s) for ActivitiesNames separated by commaExperience Mahone Bay & Lunenburg (A World UNESCO Site) - Thursday September 8 - (10:00 am - 4:00 pm)For registrants and/or guests Departing 10:00 am (Meet in Lobby at 9:45 am) Halifax Marriott Harbourfront Hotel. Includes Guide, luncheon, transfer and all taxes and gratuities Price: $ 115.00 CAD Quantity: Guest Name(s) for ActivitiesNames separated by commaEat, Meet and Greet, Welcome Dinner Buffet - Thursday September 8 - Halifax Marriott Harbourfront Hotel6:00 pm – 10:00 pm Cost: Free with Registration for registrants and/or their guest PLEASE INDICATE ATTENDANCE Price: $ 0.00 CAD Quantity: Guest Name(s)Names separated by commaHistoric Halifax Public Gardens, Shop and Dine, Friday, September 910:00 am - 3:00 pm - partner/guest event. Departing Halifax Marriott Harbourfront Hotel @ 10:00 am. Meet in Lobby at 9:45 am Price: $ 115.00 CAD Quantity: Guest Name(s)Names separated by commaFriday Night "Ceilidh on the Wharf @ Murphy's on the Water - September 97:00 pm - 10:00 pm for registrants, speakers and guests. Meet in Lobby of the Halifax Marriott Harbourfront Hotel at 6:45 pm Price: $ 165.00 CAD QuantityPlease enter a number from 0 to 5.Guest Name(s)Names separated by commaHigh Tea @ the Lord Nelson Hotel - Partners Program, Saturday, September 1012:30 am - 2:30pm partner/guest Meet in Hotel Lobby of the Halifax Marriott Harbourfront Hotel at 12:15 noon (Hats Optional) Price: $ 65.00 CAD Quantity: Guest Name(s)Names separated by commaMembers & Non Members Luncheon - Saturday, September 1012:20pm - 1:30pm Please Indicate your AttendanceLuncheon AttendLuncheon Not AttendPresidents Party "Taste of Nova Scotia" - Saturday, September 10 - Maritime Museum of the Atlantic. All are Welcome!6:30 pm - 12:00 am Reception / Dinner / Dance, A Partner and Guest Event. Meet in the Halifax Marriott Harbourfront Hotel Lobby at 6:15 pm. Price: $ 195.00 CAD Quantity: Guest Name(s)Names separated by commaTotal $ 0.00 CAD 3 Payment DonationsYoung Authors Fund - Additional Donation-- select fund amountAuthors Fund $50Authors Fund $100.00Authors Fund $150.00Authors Fund $200.00Dental Students Award Fund - Additional Donation-- select fund amountStudents Award Fund $50Students Award Fund $100.00Students Award Fund $150.00Students Award Fund $200.00Total $ 0.00 CAD Starfield Security Payment Type*Visa,MasterCard and Cheque Only!Select--VisaMastercardChequeName On CardCredit CardExpiry Datemm/yyAlternative Payment Pay By Cheque If paying by cheque, please make cheque payable to "CARDP" for the Total Cost above. Please click "Register" below, then include your name and cheque by mail to: CARDP / ACDRP Administration PO Box 665 Dartmouth, Nova Scotia, B2Y 3Y9 E-Mail: firstname.lastname@example.org EmailThis field is for validation purposes and should be left unchanged.