OPERATING ROOM NURSES ASSOCIATION OF CANADA

21st National Conference
The Depth of Perioperative Nursing...What Lies Beneath
St. John's, NL
June 7th - 12th 2009

DELEGATE INFORMATION
Last Name First Name
Address
City Province Postal Code
Country
Home Phone Home Fax Home Email
Food Allergies:
Would you like to receive information from Tourism Newfoundland & Labrador? Yes

HOSPITAL\FACILITY INFORMATION
Hospital\Facility
Address
City Province Postal Code
Country
Work Phone Work Fax Work Email

ORNAC PROFESSIONAL INFORMATION
Please choose all that apply of the following:
ORNAC Member RN CPN (C) Educator RNFA Student
CORL Administration Manager Team Leader Other:

CONFERENCE EDUCATION EVENTS\FEES
Your Provincial Operating Room Nurses Association Membership Number is required to qualify for the ORNAC member conference rate:
#
Early Bird Registration is no longer available. ORNAC Member Non-Member
  Early Bird Rate Regular Rate Early Bird Rate Regular Rate
Full Conference Rates June 7th - 12th 2009 $700.00 $700.00 $800.00 $800.00
Daily Conference Rates Monday June 8, 2009 $250.00 $250.00 $275.00 $275.00
Tuesday June 9, 2009 $250.00 $250.00 $275.00 $275.00
Wednesday June 10, 2009 $200.00 $200.00 $225.00 $225.00
Thursday June 11, 2009 $225.00 $225.00 $250.00 $250.00
Friday June 12, 2009 $170.00 $170.00 $195.00 $195.00
Total Registration Fees:
Payment by cheque only. Confirmation of registration will be sent by email once payment has been received.
SOCIAL EVENTS
**All social events are included in the price of full conference registration for the registering delegate. No additional tickets will be sold. HST is included in all prices listed.
An Evening at The Rooms - Monday, June 8, 2009

A Scoff, A Scuff and A Swalley - Tuesday, June 9, 2009

Rally in the Alley - Thursday, June 11, 2009

PHOTO RELEASE FORM

In the course of activities, representatives of ORNAC, members, non-member participants may take photographs or otherwise record events. These photographs and recordings are sometimes submitted to CORNJ to be used to promote ORNAC. Please advise us if you are willing to have your own image used for promotional purposes by ORNAC, as indicated below:

I, on my own behalf, give permission to the Operating Room Nurses Association of Canada to photograph and record me on still photographs, audio tape, or digital media and to use this material, and/or similar material provided to ORNAC by me or third parties involved in ORNAC events, in whole or in part, now and in the future, through the media of television, film, Internet, multi-media presentation, radio, audiotape, videotape, in printed form and display form for the promotion of ORNAC. I, on my own behalf assign and transfer to the Operating Room Nurses Association of Canada any and all proprietary rights, including copyright, and waive all personality rights, which I may have in this material.
I understand and agree with these terms: Signature
 
CHEQUE PAYABLE TO : 2009 ORNAC CONFERENCE MAIL TO: McCarthy's Party, 566 Water Street, St. John's, NL, Canada, A1E 1B8
EMAIL: ornac2009@mccarthysparty.com | PHONE: 1-888-660-6060 | DEADLINE FOR ONLINE REGISTRATION FORM & FEES: May 15, 2009

Note: Post-dated cheques will not be accepted. Refund Policy: After May 15th, 2009 an administration fee of $25.00 will be levied.
No refunds after June 1st. A charge of $40.00 will be levied on all NSF cheques.
Receipt will be sent via email.