EXHIBITION SPACE PURCHASE FORM Please sign and return this document via email to chris.kianza@ccafrica.ca to register for an exhibition space Name of company: Address: City: Province: Postal Code: Country: EARLY BIRD Member $2,000 + HST and 2.75% service fees (Total $2,335) (Total N 363,531.48) Non-Member $2,750 + HST and 2.75% service fees (Total $3,210.63) (Total N 499,856.56) REGULAR RATE Member $2,500 + HST and 2.75% service fee (Total $ 2,918.75) (Total N 454,414.35) Non-Member $3,300 + HST and 2.75% service fee (Total $3,852.75) (Total N 599,826.94)
First Name: Last Name: Job Title: Email: Telephone 1: Telephone 2: Fax:
Wire Transfer Swift Code: royccat2 Transit: 00006 Account: 1001650 Date wire was sent: Month
Day
Royal Bank of Canada Sparks and Metcalfe 90 Sparks Street Ottawa, ON K1P-5T6 Canada
Cheque (Only for Canadian Participants) Cheques Payable to Canadian Council on Africa. Mail to 116 Albert St, Suite 702Ottawa, Ontario, K1P5G3 Credit Card: Visa MasterCard Card Holder Name: Card Number: Expiration: Signature: Terms & Conditions: Full payment must accompany contract. Acceptable methods of payment include select credit cards
SubTotal: HST: Total:
(VISA, MasterCard); cash; and company, certified, or cashier’s check (checks payable to Canadian Council on Africa). Requests for cancellations must be made in writing to CCAfrica and postmarked on or before April 19, 2013, to receive a full refund. A cancellation fee of $250 will be charged to cover processing costs. No refunds will be made for cancellations postmarked after April 21, 2013 or for no shows. Regular Forum registration does not include exhibition space rental fees. CCAfrica will accept applications for exhibit space from all organizations/companies looking to promote their business, product, or concept to forum participants. Space will be assigned on a first-come, first-serve basis.
Send by Fax: (613)565-3013 or by E-mail to chris.kianza@ccafrica.ca For More Information Please Contact: Chris Kianza, Vice President, Business Development and Member Relations Phone: (613) 565-3011, Email: chris.kianza@ccafrica.ca
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