Client Registration Questionnaire

PRIMARY CONTACT PERSON

Fields marked (*) are required.

Please provide a primary contact person for this event, including the person's phone number and e-mail address. This information will be listed on all registration confirmations received by event participants. Please note that to protect the integrity of the registration process, CivicInfo BC will take instructions only from this person.

1.*First Name:

2. *Last Name:

3. *Phone

( ) - Ext.

4. Fax:

( ) -

5. *E-mail:

EVENT DETAILS

1. *Name of your event:

2. *Event Begins:

Start Time:

3. Event Ends:

End Time:

4. *The address where your registration form will be located follows this format:
www.civicinfo.bc.ca/Conference/***********.asp. Please provide a descriptive word or short phrase that would you like to appear in place of the (*) asterisks.

Suggested URL:

5. *Where, specifically, is your event being held? Please provide complete information below:

	Name of the Facility:
	Address of the Facility:
	City:
	Province:

6. On what day would you like registrations to open?

7. What is the last day on which you wish to accept registrations?

8. What is the maximum number of registrations you can accept for this event?

9. All CivicInfo BC registration forms collect a participant's name, title, organization, and complete contact details. When meals are served, we also collect information about special dietary needs. What other information do you need us to collect on your form? Please use the space below to describe your requirements.

10. Do you have any special instructions that you wish to include on the registration form?

11. Do you have an event brochure or flyer? If so, please attach a copy of the final version here:

EVENT FEES AND PAYMENT OPTIONS

1. What is the price of your event? Please be specific, and if applicable, include information about member prices, non-member prices, and 'early bird' prices.

2. If you have an 'early bird' price, what is the last day that price is in effect?

3. Would you like CivicInfo BC to collect online credit card payments? Our standard service includes VISA and MasterCard processing, and fees of 3.3% apply. (If you wish to accept American Express, please contact CivicInfo BC for details.)

Yes

4. Do you wish to accept cheques as a method of payment?

Yes

5. If registrants may pay by cheque, cheques should be sent:

	To CivicInfo BC. (Processing fee of $2 per delegate applies, if payment made by cheque.) I understand that CivicInfo BC holds funds in trust; and that payment is made to organizers after the event is over.
	Directly to event organizers at this address:

6. What is your event's cancellation policy? CivicInfo BC's preferred policy is: "Full refunds up to a certain day, no refunds after that day. Substitutions allowed."
(Please note: CivicInfo BC does not charge any fee to issue full refunds. When we are instructed to issue partial refunds, we charge a $25 administration fee per partial refund.)

7. What is your GST Number? (If you do not collect GST, please respond "N/A".)

EVENT RECONCILIATION AND FINAL PAYMENT

1. *To whom should CivicInfo BC send the reconciliation and final payment for this event? Please provide a contact name and complete mailing address.

TERMS AND CONDITIONS

*I agree that, to the best of my knowledge, the information I have submitted on this form is correct and final. If I require changes to my form after the first registration has been accepted, I understand that such changes may be subject to labour charges of $50/hour. I also agree that if my event receives 5 registrations or less, a $50 minimum charge applies.