Registration Form
NORTH BAY CHAPTER PEO
45th ANNUAL PROFESSIONAL ENGINEERSDAY SYMPOSIUM
Registration received by Wednesday January 21st, 2015 will help us pre-print your name tag and help us plan lunch, etc.
“Enhancing our Future through Innovative Projects”
All events are open to the general public – bring a friend
Please e-mail or mail this pre-registration form today:
Mailing Address:Engineers’ Day
c/o Lindsay Keats
255 Carmichael Drive
North Bay, ON P1B 8G2 / e-mail:
Phone: (705) 358-1840
Please forward all registration enquiries to Lindsay Keats at the contact information above.
Individual Registration Only: (Complete this section only if you are registering as an individual)
Registrant information: / Thursday Evening Social and Reception (Registration is Free)All delegates and spouse (or guest) are welcome!
Name of Individual:
We (I) will attend ( Yes / Maybe) / No, I will not be
able to attend
Company Name:
# of people that will / might attend:
Phone Number:
E-mail Address: / Engineers’ Day, January 30, 2015 (Fees listed below)
Single ($35) / Couple ($60)
Please make Cheque payable to “North Bay Chapter PEO”
Company Registration Only: (Complete this section only if you are a company registering more than one employee)
Company Information / Name of Employees / Thursday Evening Social and Reception(Registration is Free)
All delegates and spouse/guest are welcome!
Company Name: / Yes Maybe No
Contact Person: / Yes Maybe No
Phone Number: / Yes Maybe No
E-mail Address: / Yes Maybe No
Yes Maybe No
Yes Maybe No
Yes Maybe No
Yes Maybe No
I am a registered sponsor for this event: Yes ( Gold, Silver) / No
Total Registration Fee = / Total # of Employees Registering: / @ $35 each = $
Please make Cheque payable to “North Bay Chapter PEO” for the total amount of the registration fee.