Company:  ___________________________ 

Address:   ___________________________ 

Contact Person:  ___________________________ 

Telephone:____________   Fax: _________________

Email:  ___________________________  Website: ___________________________ 

Participant Names

1. Name: ___________________________ 

Telephone: ___________________________  Email___________________________ 

2. Name: ___________________________ 

Telephone: ___________________________  Email:___________________________ 

3. Name:  ___________________________ 

Telephone:___________________________   Email:___________________________ 

Company Name:___________________________ 

COMMENTS/SPECIAL REQUESTS 
(PLEASE NOTE ANY DIETARY RESCRICTIONS/FOOD ALLERGIES, ETC)

Cancellations are due in writing no later than March 13, 2003.  All cancellations are subject to a $75 administration fee.  Cancellations after March 13, 2003 are non-refundable, but are transferrable.  Please contact us for details regarding this.

Pricing

Exhibit Table  $500 + HST (15%)  X _____ Subtotal:  $__________
 (includes 1 - 8’ table and meals for one representative)

Additional Table $100 + HST (15%)  X _____ Subtotal: $__________

Literature for conference Pkg $250 + HST (15%)  X _____ Subtotal: $__________
 (companies not attending)

Additional Meal tickets $100 X _____ Subtotal: $__________
 (must be purchased in advance)

ADVERTISING IN PROGRAM – circulation approx. 1000 (Enclose AD-Ready copy)

¼ Page Ad $35 + HST (15%)  X _____ Subtotal: $__________ 

½ Page Ad $60 + HST (15%)  X _____ Subtotal: $__________

Full Page Ad $110 + HST (15%)  X _____ Subtotal: $__________

TOTAL:  $_______________________

* Prices are for all three days of conference
**Registration Deadline: March 14, 2003 – a late fee of $50.00 will be charged for registrations received after this date.

Company Name: ___________________________ 

Payment Options

1.Credit Card _____________________                        Type:___________________________ 

Name of Cardholder: _____________________ 
 (please print) 

CC Number: ___________________________         Expiry: ________________________

Signature:___________________________ 

2. Cheque  To be made Payable to:   NSCC:The Assistive Technology Centre 

Send cheque and registration forms to the attention of Saundra Myers at the Assistive Technology center (per details below)

Preferred manner of correspondence: 
Mail or Email: ______________________________________

Please contact us re:
Donating an item(s) for the raffle
Sponsoring/Co-Sponsoring a coffee break 
Sponsoring/Co-Sponsoring a reception/cocktail

For Questions or further information, contact us or visit our website at http://atains.ednet.ns.ca