Registration form for 2024 CORNQ members

Terms of payment
We suggest reading first the terms of payment that you will have to accept.

Note that you must count up to two weeks after your registration with the AIISOC for your registration to be valid on ciisoq.ca

	New registration
	Replacing a registration Subscribe to replace: Confirmation number * : -

Personal Information

CORNQ's Membership Number * :

Forgotten membership number

Mrs.

Mr.

Name * :

First Name * :

Address * :

City * :

Province * : --- Select a province -- Alberta British Columbia Prince Edward Island Manitoba New Brunswick Nova Scotia Nunavut Ontario Quebec Newfoundland and Labrador Saskatchewan Northwest Territories Yukon

Postal Code * :

Phone Number* :

Personal Email* :

Enter the same email address as the one you used to register for ORNAC

Professional Information

I don't have professional Informations

Name of Integrated Health and Social Services Centre or Employer* :

Establishment * :

Address :

City * :

Province * : --- Select a province -- Alberta British Columbia Prince Edward Island Manitoba New Brunswick Nova Scotia Nunavut Ontario Quebec Newfoundland and Labrador Saskatchewan Northwest Territories Yukon

Postal Code :

Work Phone :

Extension :

Job Title / Function * : Select your job title ORNAC BOARD CORL RN RN CPN(C) TEAM LEADER RNFA EDUCATOR AHN MANAGER Other

Specify if Other  :

Professional Email  :

Enter the same email address as the one you used to register for ORNAC

Package description : *

Cost for 1 day of conference: Can$ 260 .

Dates	Hours
Friday May 28, 2021	3:30 p.m. to 9 p.m.
Saturday May 29, 2021	7:30 a.m. to 6 p.m.

Registration for the mixology workshop on Saturday, May 29, 2021 at 5 p.m. *

I will be present

Participation to the mixology workshop : No ticket

Number of participants who wants a vegetarian menu:

I will not be present

Mixology workshop

During the mixology workshop, led by a mixologist, you will learn more about alcohols and herbs as well as the basic rules for making an excellent cocktail. You will have to try to make, in turn, the best cocktail by applying what you will have learned during the workshop.

One week before the event, you will receive a box containing the ingredients for your first cocktail.

In order to finalize your list of ingredients, you need to get some Gin (if you don't have it at home!).

For an alcohol-free version, make sure you have sparkling water or a carbonated drink such as tonic.

We advise you to have the following items handy:

• Shaker or equivalent container (a Mason jar, a Tupperware ...)
• Measuring cup or measuring spoon
• Cutting board
• Knife
• Tumbler or Highball glass.

Warning: count(): Parameter must be an array or an object that implements Countable in /home/ciisoqca/public_html/wp-content/themes/bulledev-boilerplate/php_data/questions_supp.php on line 10

Warning: count(): Parameter must be an array or an object that implements Countable in /home/ciisoqca/public_html/wp-content/themes/bulledev-boilerplate/php_data/questions_supp.php on line 25

Credit Card Information

Firstname* :

Name* :

Postal Code* :

Card number* :

Expiration date*  : - Month - 1 2 3 4 5 6 7 8 9 10 11 12 - year - 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044

CVV* :

I accept the terms of payment stated on this site.

Total : Can$ 0
Replacement / already paid : Can$ 0

TOTAL PAYMENT : Can$ 0

CONFIRM YOUR INFORMATION BEFORE SUBMITTING

Replacing a registration Subscribe to replace Confirmation number : Empty-Empty
Personal Information
CORNQ's Membership Number :	Empty
Gender :	Empty
Name :	Empty
First Name :	Empty
Address :	Empty
City :	Empty
Province :	Empty
Postal Code :	Empty
Phone Number :	Empty
Personal Email :	Empty
Professional Information
Name of Integrated Health and Social Services Centre or Employer :	Empty
Establishment :	Empty
Address :	Empty
City :	Empty
Province :	Empty
Postal Code :	Empty
Work Phone :	Empty
Extension :	Empty
Job Title / Function :	Empty
Specify if Other :	Empty
Professional Email :	Empty
Credit Card Information
Firstname : Name : Postal Code / Doctorate : Card number : Expiration date : CVV :
2024 CORNQ provincial conference registration
Number of days :	Empty
Participation to the mixology workshop :	Empty
Total : Empty Replacement / already paid : Empty
TOTAL PAYMENT :	Empty

Are all information correct ?

   

Submission of the form in progress...   

Currency : All payments are in Canadian dollars only.

Cards accepted : You can complete transactions using Visa or MasterCard.

Privacy Policy : The CORNQ site is secured with SSL standard and, through their highly secure connections, Desjardins and Optimal, ensure the confidentiality of information that you submit during the transaction. All personal information collected will be used only for the payment of sites and enrollment management and will, under no circumstances be sold to any third party.