The Dynamic ISM: A celebration of the Canadian Galactic Plane Survey
Registration Form

Use these links to navigate between steps
Step 1
Contact Info
Step 2
Accommodation
Step 3
Payment
Step 4
Confirm
Step 5
Submit

 
  Contact Information
** Indicates required information
 
  ** Name
To appear on your conference ID
 
First Name
Last Name
 
  ** Organization/Affiliation  
  ** Mailing Address
 
  ** City  
  Province/State  
  ** Country  
  ** Postal/Zip Code  
  ** Phone Number
Please include area code and/or dialing prefixes from North America
 
  Fax Number
Please include area code and/or dialing prefixes from North America
 
  ** Email Address  
  Please check this box if you are applying for financial assistance. (Deadline is April 16, 2010)  
  Notes directed to the financial assistance coordinators  
  Number of guests who will accompany you to Naramata  
  Please indicate any health related or access requirements  
  If known, please indicate your date/method of arrival to Naramata.
(e.g. Arriving by air via Kelowna on Saturday, June 6)
 
  Miscellaneous notes directed to the registrar