Bereavement Ontario Network’s 26th Annual Fall Conference

October 13-15, 2016

Geneva Park YMCA Conference Centre, Orillia, Ontario

REGISTRATION FORM

(Please duplicate for each attendee)

Name:
Address:
City: / Postal Code:
Phone No: / Email:
Organization:

Are you currently a member of Bereavement Ontario Network? Yes No

If YES, are you an individual, group, or organization member? Individual Group Organization

I am a group/ organization member under the name: ______

If NO, I would like to apply for a membership in BON (membership is renewed annually) Yes No

Are you currently enrolled in a full time program related to grief, bereavement and end-of-life care? Yes No

If YES, please provide school and program name: ______

If you are not a current member please take this opportunity to apply for a membership and receive member rates. Membership form is available at www.BereavementOntarioNetwork.com. / Postmarked on or before September 12, 2016 / Postmarked after
September 12, 2016
PLAN
(Please check one) / 2016
Member / Non-
Member / Student Special** / 2016
Member / Non-
Member
 / SPECIAL: Pre Conference + Main Conference (for Members only) / $725 / - / $635 / $765 / -
 / Accommodation Wednesday night (incl. Dinner) & Thursday breakfast / $140 / $140 / $140 / $140 / $140
 / Pre Conference Education Day (FULL DAY) Thursday lunch / $135 / $165 / $135 / $135 / $165
A
 / Full conference registration, all meals*
Accommodation Thursday and Friday nights / $625 / $760 / $500 / $685 / $820
B
 / Conference registration Friday and Saturday only
Accommodation Friday night. All Meals Friday and Saturday / $570 / $705 / $500 / $635 / $775
C
 / Conference registration Friday only (Plenary and 2 Workshops)
Lunch & Dinner Friday. No accommodation / $310 / $400 / $310 / $340 / $430
D
 / Conference registration Saturday morning only (Plenary and 1 Workshop). Lunch Saturday. No accommodation / $115 / $145 / $115 / $135 / $165

* Thursday dinner; Friday breakfast, lunch and dinner; Saturday breakfast and lunch.

All costs are based on double occupancy. Room assignments will be arranged by the committee.

** Must be enrolled in full time studies in a field related to bereavement and end-of-life care.

  • If you would like a room with someone in particular, please specify: ______
  • I would prefer single accommodation (add $45.00 per night to the above rates).
  • Please list any special needs you may have: ______

Would you consider offering your vehicle to car pool from your community? Yes No

Workshop Choices

Please indicate workshop choices by number (see brochure)

Thursday Pre Conference
Dr. Katherine Shear Understanding Complicated Grief: Definition, Assessment and Treatment
Main Conference Workshop Choices
Friday Oct 14 Session 1
11:00am – 12:30pm / Friday Oct 14 Session 2
1:30pm – 3:00pm / Saturday Oct 15 Session 3
9:00am – 10:30am
Choice / Workshop Number / Choice / Workshop Number / Choice / Workshop Number
First / First / First
Alternate / Alternate / Alternate

All workshops are assigned on a first-come-first-serve basis.

There will be a limit on number of attendees per workshop. Early registration ensures your workshop choices.

Please choose an alternate for both days should your first choices not be available.

Cancellation fee: $100.00 Final date for cancellation: OCTOBER 3, 2015

REGISTRATION FEE CALCULATION
(fill in the ones that apply)
Amount
Pre Conference Fee
Tuesday Night Accommodation (night before Pre Conference)
Pre Conference + Main Conference Special (members only)
Main Conference Fee – Option ____
Single Room Supplement if required ($45. PER NIGHT!)
BON Membership
(attach membership form – available on website)
TOTAL REGISTRATION FEE
Make cheques payable to Bereavement Ontario Network

Mail completed registration and payment to:

Bereavement Ontario Network

174 Oxford St, Woodstock, ON N4S 6B1

Payment with credit card can be made via PayPal on our website at www.BereavementOntarioNetwork.ca/conference and registration emailed to

If you have questions or need further assistance with your registration please email

After registration is processed, you will receive via email further details regarding the conference. Thank you