Attending Hip-Attack Toronto

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Full Name - Enter your name as shown on your passport.

Are you attending the PCC *

Yes No

Title

Given Name 1 *

Given Name 2

Surname 1 *

Surname 2

Name Badge *

Gender *

Birth Date *

Month Day Year

Study Position Title *

Institution *

Centre # *

Country *

Passport Details

IMPORTANT: There is an entry requirement for Canada in effect: visa-exempt foreign nationals need an Electronic Travel Authorization eTA to fly into Canada. Travellers with a valid Canadian visa are exempt. To find out whether this is required for your country or to apply for an eTA, please visit: https://www.canada.ca/en/immigration

I require an entry visa to Canada *

Yes No

All delegates are requested to check with their local Canadian Embassy for visa requirements. Visa letters require the information below.

Country of Issue

Passport #

Date of Issue

Date of Expiry

Contact information

Home Phone

Mobile Phone

Business Phone *

Extension

Your Email *

Fax Number

Travel Information

Air travel can be arranged locally for reimbursement at later date (upon approval of the estimated cost) or can be arranged through the Project office in which case you will receive confirmation of your flight arrangements directly from Heming Group within 7 days of registration.

I will arrange my own travel. *

Yes No

If yes, provide estimated cost (lowest economy airfare)

Transportation

City of Departure

Preferred Airline

Frequent Flyer#

Arrival Date

Month Day Year

Preferred Arrival Time

Preferred Seating

Departure Date

Month Day Year

Preferred Departure Time

Please note, airport transfers will not be arranged for this meeting. You will be responsible for arranging your own transfers between the airport and hotel. Taxi fare will be reimbursed at a reasonable amount up to $55 each way + gratuity. There is also an Express Train between Pearson Airport and Union Station that takes about 25 minutes at a cost of $12.

Are you bringing a guest? *

Yes No

If Yes, provide the name of your guest

*Hotel will charge your credit card for the difference from single to double occupancy (if you require triple or quadruple occupancy, please inquire regarding pricing)

Guests will not be allowed to attend the meeting or dinner.

NOTE: Please contact hipattack@phri.ca for details and costs.

Do you require Hotel Accomodation? *

Accommodation will be provided at The Westin Harbour Castle, 1 Harbour Square, Toronto, M5J 1A6 ON, CA, +1-416-869-1600; marriott.com/thewestinharbourcastle

If YES, completion of dates below are REQUIRED.

Single accommodation will be provided for the nights of October 31st and November 1st.

* PHRI can book additional nights at your own expense, at a group rate of $229.00 CAD (single occupancy) $269 CAD (double occupancy) $309.00 CAD (triple occupancy) $349.00 CAD (quad occupancy) + 13 % HST and 4% MAT tax (subject to change without notice) per room per night. Guestroom rates includes buffet breakfast for One (Single) or Two (Double) or three (Triple) or four (Quad) at leisure in Mizzen Restaurant. (Note: once our room block is full, we will not be able to offer the group rate).

Check in Date *

Month Day Year

Check out Date *

Month Day Year

Type of room

Dinners

I will require dinner on Oct 31st

Yes No

I would like to attend the dinner on Nov 1st

Yes No

Special Services

Special Dietary Needs

Special Service Request

Additional Information

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Glad to hear you are attending Hip-Attack Toronto

Accommodations