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Shopper Marketing Forum 2014 Registration Form

If you have a promo code, please enter it here:

For registration inquiries and group rates, please contact Karlie Villamor at kvillamor@brunico.com or 416-408-2300 x382.

*Fields marked with red asterisks () are required. Read the fine print for cancellation and substitution policies.**
First Name	* Required
Last Name	* Required
Job Title	* Required
Company	* Required
Primary Business	Required
Address	* Required
Address2
City	* Required
State/Province	* Required
Zip/Postal Code	* Required
Country	* Required
Company Phone	* Required
Direct Phone	* Required
Email Address	* Invalid Email Address
Please verify the email address	* Does not match

This form is being completed by the attendee indicated above Yes No
Please provide the following:
Name	* Required
Title	* Required
Phone	* Required
Email	* Required
Verify Email	* Required
Assistant	Yes No

Method of Payment * Visa MasterCard American Express Required
Card Number	* Required
Expiry Date	Required Required *
Cardholder Name	* Required
If the name on the credit card is someone else, then what is your relationship to this person? Required
Please Indicate how you learned about this event * Required
Please specify: * Required
COVID-19 Waiver: Cancellation Policy: Should you be unable to attend this event, we require notice in writing on or before January 31, 2014 at 5pm, EST. Cancellations made after this date will not be eligible for a refund. All cancellations are subject to an administration fee equal to 50% of the invoiced purchase price. All prices are quoted in CDN$. Your registration may be transferred to another individual at no charge. Should you wish to transfer your registration to another person, please inform us by email (smfcustomercare@brunico.com), a minimum of 24 hours prior to the event. Please be sure to include the following details: Name and Title of Attendee taking your spot, Direct Phone and Fax Number, Email Address, Company Details. If for any reason whatsoever the conference is cancelled, the liability of Brunico Communications Ltd. shall be limited to reimbursement of the conference fees. Producer reserves the right, with reasonable notice, to change program dates and venues and assumes no liability for the changes. Your Privacy: Information collected through this web form is subject to our privacy policy and is collected for the following express purposes: To fulfill your registration request To accurately obtain your information To contact you regarding your registration: to verify the information supplied by you; to allow you to make changes to your information; to confirm your registration; to issue a payment receipt; to issue an invoice; to solicit your feedback regarding the event; to inform you of changes to the schedule or new developments related to the event. Contact may be made via email, mail, fax or telephone. To include your information on the event's published delegate list

Shopper Marketing Forum 2014 Registration Form

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