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2012 Conference Overview Topics & Speaker Details Location & Accommodations ICTA Awards Overview

Online Registration Registration Fees Sponsorship Opportunities 2012 Sponsors & Supporters

Use this form to register up to 5 delegates for the 2012 Technology Conference / ICTA Awards Luncheon.

For inquiries or special registrations (including speakers, panel members, and large groups), please contact Doug Grant at 416-921-7756 or doug.grant@insurance-canada.ca.

For Brokers, we will be applying for RIBO Credits in the Management Category

Conference and ICTA Luncheon Fees

• Conference registrants automatically receive reservations for the ICTA Awards Luncheon on conference day.
• The conference registration fee is $750.00 or $700.00 each for two or more.
• Standalone Awards Luncheon reservations are available for $175 – or $125 each for two or more.

Fields marked by asterisks (*) are required.

General Registration Information

How did you learn about the 2012 Technology Conference and ICTA Luncheon?
* I heard about this event from:		select one: 1. Insurance-Canada.ca website or email 2. CI Top Broker email or website (CITB-1) 3. CI Top Broker magazine ad (CITB-2) 4. A conference speaker or sponsor 5. An industry association 6. A colleague or other
Our agreement with conference sponsors is that with permission they may contact delegates once prior to the event and once more afterward. This choice will apply to everyone you register at this time. Each person can then opt in or out by following instructions in their confirmation note. Please indicate your preference below.
* Sponsor contact:		select one: Yes No

 

Special Registration Code

For employees and broker guests of our sponsoring organizations, if you have been provided with a special registration code, please enter it below.
Registration code:		(Leave blank if not applicable)
Questions? Email your name, company and phone number to Codes@Insurance-Canada.ca.

 

Delegate #1 Registration

* Name:
* Title:
* Company:
* Type of Firm:		select one: Insurer Reinsurer Intermediate Distributor / MGA Broker / Agent / Advisor IT Supplier to Insurance Claims Services Supplier to Insurance Legal Services Supplier to Insurance Financial Services Supplier to Insurance Consulting Services Supplier to Insurance Other
* Location:		select one: Canada - Alberta Canada - British Columbia Canada - Manitoba Canada - New Brunswick Canada - Newfoundland Canada - Nova Scotia Canada - Ontario Canada - P.E.I. Canada - Quebec Canada - Saskatchewan Canada - N.W.T. Canada - Nunavut Canada - Yukon United States Outside of Canada & U.S.
* Telephone:
* Email:
* I am registering for:		Technology Conference (includes ICTA Luncheon) ICTA Awards Luncheon only

 

Additional Registrations

Delegate # 2
	* Name:		* Email:
	* Title:		* Registering for:	Technology Conference (incl. Luncheon) ICTA Awards Luncheon only
Delegate # 3
	* Name:		* Email:
	* Title:		* Registering for:	Technology Conference (incl. Luncheon) ICTA Luncheon only
Delegate # 4
	* Name:		* Email:
	* Title:		* Registering for:	Technology Conference (incl. Luncheon) ICTA Awards Luncheon only
Delegate # 5
	* Name:		* Email:
	* Title:		* Registering for:	Technology Conference (incl. Luncheon) ICTA Awards Luncheon only
If anyone, in addition to the Delegates listed above, should receive an email confirmation / invoice for this registration, please complete the following fields:
	Name #1:		Email #1:
	Name #2:		Email #2:

Tax Status & Total Payable

	13% Ontario HST (#896155777) applies to all registrations without an exemption number
	HST-Exempt Canadian Organization		* HST tax-exempt number:
	Conference Delegates:		Rate:		Fees:
	Luncheon-Only Attendees:		Rate:		Fees:
				Subtotal:
				Taxes Due:
				Total fee payable:

Payment

Please see notes below

I will be paying online with one of the following credit cards:

I will be paying by cheque.   (See Note #2 below.)

 

Notes

1. All fees are listed in Canadian currency
2. An Invoice and Registration Confirmation email will be sent to Delegate #1 above and anyone listed as doing registrations for others. Delegates #2 through #5 will receive a personal registration confirmation by email.
3. Refund Policy: Refunds will be given for cancellations received in writing by January 20, 2012, subject to an administration fee of $100.00 plus 13% Ontario HST for a total of $113.00. Registrations after January 20, 2012 are firm. Registered Delegates who do not attend are liable for the full registration fee. Delegate substitutions are welcome at any time.
4. The above amounts are in Canadian dollars; if you are paying on-line by credit card, your credit card company will convert your payment from Canadian dollars to your currency. If you are paying by cheque, cheques must be in Canadian or U.S. funds for the above amount.
5. Questions: Contact Doug Grant, Principal, Insurance-Canada.ca Inc. by phone at (416) 921-7756 or by email at doug.grant@insurance-canada.ca