Gene-O-Rama 2005 Registration Form

April 8-9, 2005

Surname ________________________ Given name & initial________________________

Address ____________________________ City\Town ____________________________

Prov./State ___________________ Postal/Zip Code ___________________________

Telephone (______)______-_________

E-mail __________________________ Name for Badge _______________________

Fee Calculator
1. Registration
Before March 12, 2005 ($30.00)                     $__________

After March 12, 2005 and at the door($35.00)       $__________

2. Meals
Boxed Lunch (must be ordered by March 12) ($6.50)  $__________

3. Banquet
Tickets must be ordered by March 12 ($32.00)       $__________

Total Enclosed
                                                   $__________

Please make cheque or money order payable to:

OTTAWA BRANCH, OGS

Send cheque or money order along with completed registration form to:

GENE-O-RAMA
c/o 6509 Waddion Drive
Greely, ON K4P 1E7

Gene-O-Rama reserves the right to alter the programme as needed.
No refunds after March 19, 2005
Gene-O-Rama e-mail: conference@ogsottawa.on.ca.