BCTA AGM & Convention Registration Form

PRE-REGISTER NOW! SAVE YOURSELF TIME & MONEY!!

Please fill out this form to register for the BCTA Convention. Registration includes 3 lunches, 1 dinner and 5 coffee breaks.

Every person must be registered. The hall & meals are paid on a per person basis. If you register before March 1st, you qualify for the Pre-Registration draw! Also, a special prize is drawn on the banquet tickets.

You may pick up your Pre Registration package (meal tickets, banquet tickets & receipt) at the Fast Track desk at the Convention.

If you prefer, please print this form out and fax it to us at 250-962-5462. Or you can call in your order at 250-962-5452. Or you can print it out and send with your cheque made out to the BCTA, P.O. Box 1063, Prince George, BC, V2L 4V2

Name:
Address:
City:
State/Province:
Country:
Postal/Zip Code:
Telephone:
Email:

Registrations:	Adult Registrations x $55 ($65 if received after March 1st) Child Registrations x $30 ($35 if received after March 1st) Banquet & Dance x $35 ($40 if received after March 1st)

You may also renew your BCTA Membership at this time.

Level of Participation:	Individual $50 Individual 5 Year $250 Family $70 Family 5 Year $350 Corporate - Bronze $250 Corporate - Silver $500 Corporate - Gold $750 Corporate - Platinum $1000 Associate Member - First Nations $100 Associate Member - Small Business $100 Associate Member - Other Organization $100 Donation to the BCTA (no membership)

Payment Method	Visa Mastercard
Credit Card Number:
Name on Card:
Expiry Date:
Card Billing Address: (if different from above) Street address City, Province Postal code
Comments:

Note: Information used ONLY by BCTA and not shared.