Registrant Information
Company
Address
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Event Information
Event	DMAT Ultimate Cocktail Party
Event Date	Thursday, December 4th - 6:00pm - 10:00pm
Location	Cheval - 606 King Street West, Toronto

Names of Attendees: (Please use full names)
Attendee 1
Attendee 2
Attendee 3
Attendee 4
Attendee 5
Pricing
Member	1 - Ticket @ ($99.00 + GST) $103.95 2 - Ticket @ ($99.00 + GST) $207.90 3 - Ticket @ ($99.00 + GST) $311.85 4 - Ticket @ ($99.00 + GST) $415.80 5 - Ticket @ ($99.00 + GST) $519.75
	Total amount of purchase

Payment Information
Credit Card Number
Name on Card
Expiry Date

This information is being sent to a secure CGI Form server - it is not a transaction gateway. Your Credit Card will be processed manually and a confirmation will be sent when we complete the processing. If you are not comfortable with this process, please download the FAX Registration or call us to register at 416.502.0433.