CHHA 2017 Conference & Sidney, BC - May 25 - 27, 2017
   
 

Register for the Conference

Please complete the following form and click "Submit Registration" at the bottom of the page.

Contact Information

First Name*:

Last Name*:

Address*:
City*:
Province/State*:
Postal/Zip Code*:

Country*:

Canada
United States
Phone Number*:
Mobile Number:
Fax Number:
E-Mail*:
Emergency Contact Name*:

Emergency Contact Phone*:

Conference Registration

Registration Type

Early Bird -
Ends March 9, 2017

Regular Price -
March 10 - May 12, 2017

CHHA Members $280.00 $350.00
Non-CHHA Members* $325.00 $375.00
1-Day Rate (Friday only) $150.00 $150.00
1-Day Rate (Saturday - Includes Banquet Dinner) $150.00 $150.00
Couples Rate (10% Discount- Rate for 2 Registrations) $475.00 $504.00
Student Rate** $135.00 $135.00

*All rates are quoted in Canadian $$ and include tax.
*Registration for non CHHA members includes a one-year membership to CHHA national.

**A student is defined as a holder of a student identification card from a recognized tertiary or secondary educational institution or international student card. Students must be studying full-time to quality for the discounted rate. A copy of your student card must be faxes or emailed to us following the submission of your web form. Without this ID, the full registration fee will be charged.

Special Requirements

Dietary & Special Requirements:
Guest Banquet Tickets:
*Closing Banquet Tickets are included in Full Registration. Please use this section to purchase tickets for a GUEST who is NOT registering for the conference.
Price for each guest banquet ticket is $50.


Guest Name (First/last Name)


Guest Dietary Restrictions
Please specify: vegetarian, gluten free or allergies

Assisted Listening Equipment Required?

Privacy Policy

The information you provide on this form will be collected, used and disclosed only for the purposes of this conference.

I understand and accept the privacy policy:

Agree
Disagree

Payment Information

Credit Card

By paying by credit card, I understand that my credit card statement will show this transaction as "C.H.H.A" and I will ensure that anyone who reviews the statement is aware of the transaction.

Name on Credit Card:
Card Type:
Credit Card Number:
CVV Number:
Expiration Date: MM/ YY
Please provide billing address
Street number:
Street name:
Zip/Postal code:

Cheque

Please make your cheque payable to the "CHHA Conference" and mail to:

Canadian Hard of Hearing Association
Attention: 2017 CHHA Conference
2415 Holly Lane, Suite 205
Ottawa, ON K1V 7P2

Cancellations and Refunds

Requests for refunds must be received in writing before April 20, 2017 and will be subject to a cancellation fee of $50.00. No refunds will be given for cancellation after this date or for non-attendance.

Questions?

If you have any questions about the Conference, please contact Chantal Coleman by e-mail ccoleman@chha.ca or conference@chha.ca or by phone at 800-263-8068.