Canwell 2006
Registration Form

May 17 to 20, 2006 , Charlottetown, Prince Edward Island, Canada

*Fill in the form below to register to attend Canwell 2006. If you wish to register as an Exhibitor click here to go to the Exhibitor's Registration Form.

Delegate Registration

*required field

Company Name:	*
Mailing Address:	*
City:	*
Prov/State:	*
Postal/Zip:	*
Country:	*

Bus. Phone:	*
Fax:
Email:	*
Name:	*
Name 2:

Please check one:
Manufacturer/supplier	Contractor/Driller	Technical/Consultant
Guest/Other	Exhibitor	Student

One registration includes: A trade show pass, wine & cheese reception, coffee/nutrition breaks, pub night, outdoor demonstration & barbeque.

Delegates Name:

x $325.00

Delegates Name:

Student Pass (price does not include meals)

x $50.00

Wednesday May 17 - Golf & Dinner

x $90.00

Thursday May 18 - Luncheon

x $20.00

Friday May 19 - Luncheon

x $20.00

Friday May 19 - Lobster Supper

x $50.00

Saturday May 20 - Banquet & Dance

x $60.00

Spouses Package

x $50.00

Subtotal

GST # 872425962RT0001

GST

Shipping & Handling

Grand Total

Payment by Visa, Master Card or cheque (payable to: Atlantic Water Well Association)

Method of payment: Visa Mastercard Cheque

Card Number:

Expiry Date: mm yy

Cardholder Name:

Signature:

Type "I AGREE" to have your credit card debited

Send payments by cheque to:

Patti Josey, Event Coordinator, c/o Atlantic Water Well Association
# 3 - 644 Portland Street, Suite 219 , Dartmouth, N.S.. B2W 6A3
Tel: (902)-435-6636 ; Fax : (902)-434-7827 ; Email: patti.josey@iworks.net