Registration

First Name: *
Last Name: *
Organization: *
Position Title: *
Email: *
Phone (###-###-####): *
Phone Extension:
Are you a HRPA Member? *

I will be bringing guest(s).
I will be attending via? *

Guest 1

First Name:* Last Name:*
Organization: Position Title:*
Phone (###-###-####): Ext:
Email:* Is this person a HRPA Member?*
I will be attending via? *

Guest 2

First Name:* Last Name:*
Organization: Position Title:*
Phone (###-###-####): Ext:
Email:* Is this person a HRPA Member?*
I will be attending via? *

Guest 3

First Name:* Last Name:*
Organization: Position Title:*
Phone (###-###-####): Ext:
Email:* Is this person a HRPA Member?*
I will be attending via? *

Guest 4

First Name:* Last Name:*
Organization: Position Title:*
Phone (###-###-####): Ext:
Email:* Is this person a HRPA Member?*
I will be attending via? *

Billing

Method of Payment:*

NOTE: If you have any problems with processing your payment, please call us at 1-877-264-5166 or email us at wynford@wynfordgroup.com

Credit card type:*
Billing Address: *
Postal Code (A#A #A#): *
City: *
Province: *
Name on Credit Card: *
Credit Card #: *
Expiry Date (MM/YY): * /

CSV Security Code: *
(3 digit on back, 4 digit on front for AMEX)

American Express transactions are subject to an additional $5 processing fee.