BC Care Providers Association | 2011 AGM and Conference | May 15-17, 2011

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Exhibitor Application
In accordance with the terms of the contract, the organization listed below contracts for exhibit space offered by BC Care Providers Association at their 34th annual conference to be held May 15-17, 2011 at the Fairmont Chateau Whistler, Whistler, BC. Exhibit show is May 16th 7:30 am to 17th 2:30 pm.

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Title:  
* First Name:
* Family Name:
Badge Name:

(only if different from above - badge will show first and last name) 
* Organization:
Job Title:
* Address Line 1:
Address Line 2:
* City:
* Province:
* Postal Code:
* Country:
* Telephone: ( ) - Area Code with phone number
Fax: ( ) - Area Code with phone number
Special Requirements:
(e.g. dietary / mobility)
* E-Mail Address:
* Confirm E-Mail Address:

 

Conference Secretariat: The Conference Intelligence Agency,
PO Box 41069 2529 Shaughnessy St. Port Coquitlam, BC V3C 5Z9
Phone: (604) 945-3574 :: Email: registration@theciainc.com

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