- Registration Form

Section A: Program Information

Section B: Registrant Information

First Name:	Middle Initial:		Last Name:

Job Title:	Benefits/Pension Experience:
	(yrs)
Company Name:

Street Address:		City:

Province:		Postal Code:

Area Code/Phone/Extension:		Fax #:

E-mail Address:


Home Address (if applicable):
Street Address:		City:

Province:		Postal Code:

Area Code/Phone No:


Are you a CPBI member?: NO YES

Section C: Payment Information

Fee to follow
Please invoice us	Purchase Order # (if applicable)
Credit Card (the Centre will contact you for authorization)

Note:

Please make cheques payable to: The Centre for Employee Benefits.
Mail to: Centre for Employee Benefits, Humber Institute of Technology & Advanced Learning,
401 The West Mall, Suite 630, Toronto Ontario M9C 5J5. Attention: Ted Patterson
Tuition fees must be received by the Centre at least three (3) weeks prior to start of seminar,
unless otherwise agreed.
Refunds will be given for cancellations received two weeks prior to seminar date. No refunds
will be granted after commencement of a program.
Fees for Distance Education option (CEB program) must be received prior to commencement.
Questions? Contact us by phone (416) 675-5047 or fax (416) 675-7778 or e-mail to
ted.patterson@humber.ca

Section D: