CANARIE Summit 2019

CANARIE Summit 2019
Tuesday, October 1st and Wednesday, October 2nd, 2019
Your Info
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Registrant info
What type of registrant are you?
CANARIE Member
Non-Member

* Salutation
* First Name
* Last Name
* Email Address
* Repeat Your Email Address
* Company / Institution Name
Phone Number
Street Address
* City
* Province / State
Postal / Zip Code
* Country
* Job Title:
Is your organization a CANARIE Member? If your organization does not appear in the list below, please choose the last option, “No, my organization is not a CANARIE Member”.
Please identify your role(s) at the CANARIE Summit.
 Delegate / Attendee
 Sponsor
 Speaker
 Innovation Alley Exhibitor
 Media
 CANARIE Board of Directors
 CANARIE Staff
 Other
Please select your industry/field:
* How would you like your name to appear on your badge?
* Will you attend the CANARIE Reception on Tuesday, October 1st from 5:00 - 7:00 PM?
Yes
No
Do you have any dietary restrictions? If yes, please list them below:
How did you hear about the CANARIE Summit?
 CANARIE Website
 Social Media
 Personal Invitation
 Word of Mouth
 CANARIE Email List
 Other
If you answered 'Other' to the question above, please explain.
* Do you consent to being added to CANARIE´s email communication list?
 Yes
 No
* Do you consent to having your name and email address given to exhibitors and/or sponsors?
 Yes
 No
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