Member Registration Form
 

To register on-line, please complete the form below and click on submit at the end.  Please complete 1 form per person.

Note: if you prefer to print a form and to submit it by fax or email, please click here.
1 - Please enter participant information below. Do not use caps lock to fill out the form.
  Please enter your FNHMA member number here
(this is mandatory for you to receive the member rate for the conference):
*FNHMA MEMBER ID:
*FIRST NAME:
*LAST NAME:
TITLE:
ORGANIZATION:
DIVISION:
*ADDRESS:
P.O. Box/ Suite / etc.:
*CITY:
*PROVINCE:
*POSTAL CODE:
*TELEPHONE: FAX:
*E-MAIL:
2 - How did you hear about the conference?
Word of mouth
Mailing from FHNMA
Email message
Web site
Newspaper Ad
Other
3 - Registration Fee
The registration fee includes all business sessions, the opening reception on Tuesday evening, November 15, breakfast, lunch, 2 breaks and the reception and dinner on Wednesday, November 16 and breakfast, lunch and 2 breaks on Thursday, November 17, 2016.


Conference Regular Rate (as of October 8, 2016)
 FNHMA Member - $ 745
Reception and dinner ticket for guest
You may purchase a ticket for a guest for the Wednesday, November 16 Reception and Dinner ONLY
$125 Guest Name

Are you GST/HST exempt? yes no
Note: The conference is being held in British Columbia where 5% GST applies. The FNHMA HST/GST number is 811344852. If your Indian band is GST/HST exempt, please email a copy of the band's exemption certificate or letter to conference@fnhma.ca. An individual's personal status card is not an accepted document for tax exemption for the conference.
4 - Method of Payment (Your payment is required prior to the conference)
If you are paying by cheque:
1) Please make cheque payable to FNHMA
2) Mail a copy of your receipt and cheque to the
FNHMA Conference Secretariat (address below)

If you are paying by Credit Card:
1) Complete the credit card information requested below
2) We accept MasterCard and Visa ONLY
5 - Payment
Please click on "cheque" or "credit card"
to indicate your method of payment:		 Cheque
  Credit Card (MasterCard and Visa ONLY)
Registration Fee:
5% GST:
Total:
Cardholder Name:
The FNHMA HST/GST number is 811344852
Credit Card Number:
Format - no spaces or dashes between numbers
Expiry Date:
Format mmyy (example: 0712)

Your registration will be processed and confirmation of registration will be sent to you by email.
6 - Cancellation / Substitution
Cancellation of registration should be sent in writing by email. Cancellations will be accepted until October 14, 2016 for a full refund. A $300 cancellation fee will apply for cancellations received between October 15 and October 24, 2016. No refund for cancellations received after October 24, 2016 and no refund for no-shows at the conference. Substitutions are accepted at any time.
7 - Contact Us
If you have any questions about the conference, please contact Micheline Bélanger at the FNHMA Conference Secretariat.

Tel: (819) 827-5931 or toll-free 1 (866) 775-1817
E-mail: conference@fnhma.ca

Mailing address:
FNHMA Conference Secretariat
40 chemin du Roc Est
Chelsea, Québec
J9B1T1