Section 1 - Registrant Information
Please note - all fields are required to submit registration form.

Select One:	- Dr Mr Mrs Ms Miss
Last Name:		First Name:
MemberID:		Select One:	- CHSC CRSP CSSE Member Non-member
Organization:		Title:
Address 1:
Address 2:
City:		Province/State:
Postal/Zip:		Country:
Phone:		Fax:
Email:
Special Requirements   Please specify any special requirements you may have (diet, allergies, etc.)
Payment Option: (please select one)
Please Invoice       PO #   Enter Purchase Order Number:           A copy of the Purchase Order is required before the order can be processed. Please fax a copy of         the Purchase Order to the CSSE office at (416) 646-9460.       Credit Card         To expedite processing time, payment can be made by credit card. However, payment can not be         made on our site: we do not have a secure server. Please feel free to contact the office at         (416) 646-1600 to provide your credit card details, or you can fax them in to (416) 646-9460,         attention: Dani Couture.