CASAE East Conference Registration  Oct 12 -13, 2018

 

Return Address:
Mount Saint Vincent University
Faculty of Education 
Seton Academic Centre Room 401A
166 Bedford Hwy Halifax, Nova Scotia  B3M 2J6  CANADA
phone: 902-457-6372
email: jacob.smith8@msvu.ca

DEMOGRAPHIC INFORMATION: 
                                                                 

Name

                                                       

Address

                                                       

                                                       

                                                       

                                                       

 

Telephone:    (____)  _______________

FAX:             (____)  _______________

 

ADDITIONAL INFORMATION

E-Mail:                   ____________________________________________ 

Web:                   ____________________________________________ 

 

 

REGULAR  ($50.00)                                                                                 

RETIRED  ($30.00)                            

STUDENT  ($30.00)                         

UNWAGED  ($30.00)                           

 

 

Payment:  By cheque  payable to MSVU CASAE East in Canadian funds or by credit card

Name (as it appears on card)

 

 

      _____________________________________

Card Number                              VISA and MasterCard

 

 

           

Signature

 

      _____________________________________

Expiry date

 

           

            month                            year

E-mail address for credit card receipt: