Canada Forum

6th Annual Conference

POWERING UP ABORIGINAL ENERGY

Infrastructure and Economic Development Strategies
for Investment in Aboriginal Clean Energy Projects

Toronto, Ontario on April 23-24, 2012

Fee for the two-day conference is $995. If you have personally attended a Canada Forum Aboriginal Energy conference in the last 5 years, your registration fee is only $895.00. Payment must be received in advance of the conference. Please see brochure for other registration information.

I have read the information in the brochure regarding the terms of the registration.

1	Name
	Position
	E-mail	$

2	Name
	Position
	E-mail	$

3	Name
	Position
	E-mail	$

4	Name
	Position
	E-mail	$

				SubTotal
				13% HST
				Total

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Enclosed is my cheque for $ payable to Canada Forum Inc

Please charge the amount of $ to my credit card

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CVD No.*

You certify that you are in possession of your card and authorize us to charge your credit card without your signature as stipulated on this electronic form. If you have not received confirmation of your registration within 2 business days, please email us at info@canadaforum.com.

* 3-4 digit number specific to your card, on the back of the card by the signature line

Security not guaranteed. We recommend you print and fax this form if it contains credit card information Fax: 416-925-1709