Registration Instructions:   Please complete the following form carefully, but only after you have approval from the department or individual responsible for fee payment.   Fields marked with an * are mandatory.  The Form will not “SEND” without an entry in all mandatory fields.  Upon successful submission of this form, you will automatically receive a Response Letter with a confirmation.  After confirmation you may proceed with your travel and hotel arrangements.  Hotel reservations can easily be made from this Website (see the Hotel & Travel page).  Soon after we process this submitted form, an Invoice will be sent to Accounts Payable and a copy will also be sent to your work email address.

Please note that your Registration is not complete until a fee payment is received.  For Registration to be complete, we must receive payment by March 15, 2023.  Upon payment, a Confirmation No. will be emailed to work email address and the registration process is complete.  A Confirmation No. is required for admittance to the Course.  If you wish to indicate that one or more reservations are forthcoming at a later date, or if you have any other questions, feel free to email Mary Jansepar

Prior to submission, It may be useful to print a copy of this page for your records. Thank you.

FIRST NAME:	Mr. Ms. Dr.   *
MIDDLE INIT/NAME:
LAST NAME:	*
BADGE NAME:	(Optional: provide name as you wish it to appear on your name badge)
POSITION/TITLE:	*
COMPANY:	*
PLANT:
WORK ADDRESS 1:	*
WORK ADDRESS 2:
CITY:	*
COUNTRY:	Select Region Asia Africa Australia Europe Middle East Latin America North America South America <-------------------- *
STATE/PROVINCE:	--- Please select location --- --- Canada --- Alberta British Columbia Labrador Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon --- USA --- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming --- Other ---  (If Applicable)
ZIP/POSTAL CODE:	*
PHONE NUMBER:	*	FAX:
REGISTRANT E-MAIL:	*
INVOICING E-MAIL:	* (Billing/Accounts Payable/Invoicing Contact E-Mail is required!)
Please check if you will be accompanied by spouse or partner           Spouse/Partner name:
PAYMENT OPTIONS
No credit card payments accepted. Personal cheques welcome.
SELECT DESIRED CURRENCY:   $ 4,000 CAD     $3,100 USD
PAY BY MAILED CHECK (PAYABLE TO: The Brimacombe Continuous Casting Society)
PAY BY WIRE TRANSFER
(Checks or transfers covering more than one individual should clearly indicate names and confirmation numbers of all parties)
MAILING ADDRESS: WIRE TRANSFER INFORMATION: The Brimacombe Continuous Casting Society c/o Mary Jansepar, Course Coordinator 44 North Howard Avenue Burnaby, B.C. V5B 1J5 CANADA   Information will be provided to invoicing email or upon request: Course Coordinator Email: info@brimacombecourse.org