Attending ACT/AEC - Charlottetown

Glad to hear you are attending the 2nd Annual ACT/AEC Meeting

Charlottetown
Please complete this form and click Submit.
* indicates a required field

Full Name - Enter your name as shown on your government issued photo identification.
Title
First Name*
Middle Name
Surname 1*
Surname 2
Gender*
Birth Date*

MonthDayYear
Name Badge
Name as preferred on Badge
Institution Name*
ACT Category*
Please specify:*
Role/Position
Contact information
Mobile Phone*
Business Phone*
Extension
Your Email*
Travel Information
Transportation*
City or Airport of Departure*
Preferred Airline
Frequent Flyer#
Arrival Date*

MonthDayYear
Preferred Arrival Time
Preferred Seating
Departure Date*

MonthDayYear
Preferred Departure Time
Accommodations
Do you require Hotel Accomodation?*
Accommodation will be provided at one of the conference designated hotels for the nights of September 20, 21 and 22.

Additional nights will be available at your own expense.

Please contact Heming Group for details.
If YES, completion of dates below are REQUIRED.
Check in Date

MonthDayYear
Check out Date

MonthDayYear
Are you attending the ACT/ACE group dinner on September 21st?*

YesNo
Dietary Restrictions or Allergies
Additional Information
Should be Empty:

Glad to hear you are attending the 2nd Annual ACT/AEC Meeting