PORTCON Individual Industry Delegates Form – CPE Certified Port Executive™ Program

PORTCON Individual Industry Delegates Form May 4th – May 6th Below:

YOUR DETAILS

Company/Organization (required) *

Contact Name (required) *

Position/Job Title (required) *

Address (required) *

City (required) *

State or Province (required) *

Country (required) *

Zip or Postal Code (required) *

Email (required) *

Phone (required) *

PAYMENT DETAILS

Please note this form "does not" validate credit card numbers, please type in the fields correctly or contact us to make payment arrangements.

Registration Amount

How Many Days

1 Day $95
2 Days $150
3 Days $200

Select Your Card Type

Card Number

CVV (3 Digit Number)

Expiry Date

Card Holder Name

First

Last

Phone Number

Card Billing Address

Comments

How did you hear about us? (required) *

Please select an option from the drop down menu

Add Your Twitter Address

Add Your LinkedIn Address

Payee agrees to pay the total in accordance with the agreement governing use of International transactions may be subject to an additional currency conversion fee. CANCELLATION POLICY: Substitutions may be made, two weeks prior to the conference. Cancellation requests must be received, also in writing, on or before April 4th 2021. Please note that all cancellations will be subject to a 10% administration fee.

Email

Find Us at

Address: 1701 Hollis Street, Suite 800, Halifax, NS, B3J 3M8 – Canada

Phone: 866.219.6563

Mail: registration@macdonnell.com

Corporate Website: macdonnell.com

If you wish to register for a course that is within two weeks of the posted training date, please call 24/7 toll free 886.381.0461 to confirm availability.

Bank Transfers: Please contact our office at 886.381.0461