Member Pre-Conference Workshop RegistrationFNHMA 2019 National Conference Fairmont Queen Elizabeth Hotel Tuesday, November 5, 2019 1. Participant InformationFNHMA Member Number*Base Price Price: $ 595.00 CAD Quantity: Name* First Name: Last Name: Title:Organization:Division:Email:* Phone:*Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country 2. Workshop Registration FeesRegular Rate Price: $ 595.00 CAD Date Is your First Nation, Community or organization GST exempt?*NoYesNote: The conference is being held in Alberta where 5% GST applies.The FNHMA HST/GST number is 811344852. If your Indian band is GST/HST exempt, please upload a copy of the band’s exemption certificate or letter by clicking “choose file” button to find and upload your certification or letter in digital form (only .JPG, .PNG, .PDF accepted). Note: an individual’s personal status card is not an accepted document for tax exemption for the conference.Certificate or letter File Upload*Accepted file types: jpg, jpeg, png, pdf.3. PaymentPlease Choose Your Payment Method*Pay by Credit CardPay by ChequeFNHMA only accepts Visa, Mastercard, or chequeSubtotal $ 0.00 CAD Add 5% GST $ 0.00 CAD Total $ 0.00 CAD Credit Card* MasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name 4. CancellationCANCELLATION / SUBSTITUTION*Please email your cancellation to email@example.com. Cancellations will be accepted until October 4, 2019 for a full refund. A $300 cancellation fee will apply for cancellations received between October 5 and October 18, 2019. There is no refund for cancellations received after October 18, 2019 and no refund for no-shows at the conference. Substitutions are accepted at any time. I agree to the Cancellation / Substitution Policy. Confirmation ID Number This iframe contains the logic required to handle AJAX powered Gravity Forms.