Occupational Health and Safety Training - Registration Form

NAME (please print)

ADDRESS     

CITY/PROV./ POSTAL CODE     

DEPT/AGENCY

GROUP                    

TELEPHONE (HOME)

TELEPHONE (WORK)     

PIPSC MEMBERSHIP NUMBER

E-MAIL (will be used for all correspondence)

ACCOMMODATION

Yes
No     

Room for Friday, November 30, 2018 (for members who cannot arrive at the meeting location without having to leave home prior to 7:00 am on Saturday morning)

Room for Saturday, December 1, 2018 (for members who cannot arrive home by 8:00 pm on Saturday night travelling by the most direct route including a one hour meal stop)

MEALS

Standard
Vegetarian
Other (please specify)  
    
SPECIAL REQUIREMENTS (for meals and accommodation)     

DRIVING

Yes
No
AIR TRAVEL

Yes
No

Once we have confirmed your registration, please contact BCD Travel in Ottawa at 1.866.768.7624 or reservations1.ca@bcdtravel.com to book your air travel, only.  Please do not book your accommodation with BCD Travel.

SIGNATURE
DATE     

PLEASE RETURN YOUR REGISTRATION by October 22, 2018 by pdf to pfung@pipsc.ca or fax to 604.688.8290 or 1.800.330.1988
REGISTRATIONS WILL NOT BE ACCEPTED BY TELEPHONE