CSS 2018 Conference Registration

Registration for the 18th Annual Scientific Conference of the Canadian Spine Society
must be done online using this form

*** The registration deadline has now passed. You can still register online or on-site at the conference
however a $75 late fee will be added to your registration.
***

This registration form is for individual registrants only.
If you are attending as an Exhibitor please contact the CSS office to register.

Prices shown do not include tax; HST will be applied at a rate of 13%
HST #: 832531073 RT0001

REGISTRANT INFORMATION

Fields marked with a * must be completed.

MD Allied Health Professional Resident Fellow Other: If other, please specify:

PREFERRED TITLE* (DR., MR., MRS., MS.) :

FIRST NAME* :

LAST NAME* :

MAILING ADDRESS* :

CITY* :

PROVINCE* :

POSTAL CODE* :

EMAIL:*

PHONE* (eg. 123-456-7890) :

REGISTRATION FEES

Name on Credit Card, Cheque or E-transfer that will be used to pay registration fees *

To pay by cheque: Please print a copy of this form and mail it with your cheque

To pay by E-transfer: Please send the transfer to css@spinecanada.ca and make the answer to the security question: Banff2018

I will be paying my registration fees by* :

Cheque Paypal E-transfer to css@spinecanada.ca

Registration Type * :

Registration fee INCLUDES (for registrants only): breakfasts, coffee breaks, CPSS session, symposia and scientific presentations, Opening Welcome Reception, Presidential Banquet.

Wine tasting tickets and guest tickets for the Presidential banquet are extra.

Not sure which category you should register in?
Please contact the CSS office for assistance: css@spinecanada.ca

Membership: If you are not currently a member of the Canadian Spine Society and would like to apply for membership please contact Jennifer Edwards at the CSS office.

Choose your registration type:

$950.00

Non Member (surgeons, chiropractor, physiotherapist, other)

$725.00

CSS Members
CPSS Surgical Members
Senior CSS Members

$625.00

Nurses
Allied Health Professionals
Non-medical Healthcare Professionals
Non-surgical CPSS Members

$525.00

Non-member Fellows and Residents
Medical Students

$475.00

Fellow and Resident CSS Members

$250.00

Single Day Rate for CPSS Session on Feb 28

SCIENTIFIC SESSIONS

WEDNESDAY
February 28   0700-1200 hrs
CPSS - Canadian Pediatric Spine Society - Morning Session*:

YES, I will attend NO, I will NOT be attending

WEDNESDAY
February 28   1245 to 1615 hrs
CPSS - Canadian Pediatric Spine Society - Afternoon session *:

YES, I will attend NO, I will NOT be attending

THURSDAY
March 1   1245 to 1500 hrs
Case Presentations for Residents / Fellows / Allied Health Professionals*:

YES, I will attend NO, I will NOT be attending

FRIDAY
March 2   1245 to 1500 hrs
Case Presentations for Residents / Fellows / Allied Health Professionals*:

YES, I will attend NO, I will NOT be attending

SOCIAL EVENT TICKETS

WEDNESDAY
February 28   1830 to 2100 hrs
Opening Welcome Reception, Exhibits & Registration* :

YES, I will attend NO, I will NOT be attending

Number of ADULT guests attending

Number of CHILDREN attending (12 and under)

THURSDAY
March 1   1800 to 1900 hrs
Wine Tasting* :
Must be age of majority to attend.

Tickets are $35 each
NOTE: Wine tasting tickets are NOT included in the price of registration.Enter 0 if you do not wish to purchase guest wine tasting tickets.

YES, I will attend NO, I will NOT be attending

Number of GUEST tickets

THURSDAY
March 1   1900 to 2100 hrs
Presidential Banquet* :
Age of majority event; semi-formal event.

YES, I will attend NO, I will NOT be attending

Number of GUEST tickets
NOTE:
One Presidential Banquet ticket is included in the registration fee for each registrant; guest tickets are $110 (plus HST) each. Enter 0 if you do not wish to purchase guest banquet tickets.

REFUND POLICY AND LATE FEE

A registration refund will be made upon written request on or prior to February 5th, 2018; an administration fee of $35 will be retained. Any refunds granted after February 5th, 2018 will incur an administrative fee of $75. A late fee of $75 will be applied to all registrations received after February 5th, 2018.


© 2017 CSS • Online Registration System by: DragonflyDesigns.ca