Secure EPIC Registration

National Elder Planning Issues Conference

Your Name - CIPR # (if applicable)

Are you an EPC Member? Yes No

Are you a Charter Member? Yes No
Spouse Yes No

Company name:
Are you registering a guest?
1st Guest Name - For name badge:
2nd Guest Name - For name badge:

Your Information
Street :
City:
Province:
Postal code:
Business Phone:		Ext:
Home Phone:
Cell Phone:
Fax:
E-mail Address:

Location -

Questions? Type anything you have a question about here and we will get back to you.

Registration Fees - Niagara Falls TAX included

- The conference fee for members is $399.00
- Non Members - $449.00
- * Spouse of EPC Member/Non Member - $199.00

Registration Fees - Edmonton Conference TAX included

- $169 EPC Member fee
- $199 Non-member fee
Spouse of EPC Member/Non Member - $99

NOTE - * Current EPC members may not be registered as a spouse or guest

Payment Method

For Credit Card Payment's we accept the following cards

Visa

MasterCard

Card Number: Expiry Date

* EXAMPLE - 5555 4444 3333 2222 (please leave space between each four numbers)

CVV2# (3 Digit Code on the back of your Credit Card)

Name on card:

I will send an E-Transfer Please send E-Tranfers to: payments@cieps.com (No Password is Required)

For Payments made by Cheque
Make checks payable to - Canadian Initiative for Elder Planning Studies

I will Mail my Cheque

Mail your cheque to -

Canadian Initiative for Elder Planning Studies
Suite 203, 4438 Ontario Street
Beamsville, ON
L3J 0A4

Type 1234 in the box to the right then click Submit Form:

Canadian Initiative for Elder Planning Studies Inc.
203-4438 Ontario Street

Beamsville, ON L3J 0A4

Toll Free Phone 866 833-8606 Toll Free Fax 866 209-5111