First Name: Last Name:

Title: Organization:

Years in position:

Business Mailing Address:

City: Province / State:

Country: Postal / Zip Code:

Business Phone: Business Fax:

Email address:

Program Selection:

Program Name:

Program Dates:

Cancellation / Substitution Policy:

You will be charged as follows: if you cancel 30 or more days prior to the start of the program - $500 (to cover administrative costs); 15 - 30 days prior to the start of the program - 50% of tuition fee; 1 to 14 days prior to the start of the program -100% of tuition fee and an assessment for accommodation fee, based upon facilities charges.

We welcome substitute participants, provided they meet all admission criteria (determined by the selection committee) and are able to complete all pre-course material prior to the start of the session.

I have read & accept the above cancellation/substitution policy - choose yes or no:

Yes No

Payment Options: To retain your place in our Governance and Executive Leadership programs we require a minimum $500 deposit. The balance of fees is required no later than 30 days prior to the program start date.

Payment Options: Mastercard Visa

Credit Card #: Expiry Date m/y:

Name as it appears on Card:

$500 Deposit (balance to be paid 30 days prior to program)

Full Payment

Is your organization GST exempt? (enter yes / no)

Exemption Number:

 

Arrival / Departure / Special Requests:

Note: Check in time is 4:00 p.m. and check out time is noon.

I plan to arrive on: (time and date):

I plan to leave on: (time and date):

We will do our best to accommodate special lodging and meal requests. Our desire is to ensure your stay is as comfortable and enjoyable as possible. To do so, we ask that if you have any dietary concerns that you let us know in advance. Unfortunately, if we do not have prior notice of concerns, we would not be able to accommodate any substitutes. Please submit any special requests:

Please enter any additional comments or question(s) here: