Registration FormRegistrationStep 1 of 5 – Personal Information20%Name(Required) First Last Email(Required) Phone(Required)Organization/Institution(Required)Role(Required)Preferred PronounsPreferred Name on BadgeParticipant Type(Required) Speaker Student (Full-Time) General PublicDietary Preference Vegan Vegetarian Pescatarian HalalDietary Allergies Gluten Nuts Dairy OtherOther Dietary AllergiesHow severe are your dietary allergies?Comments on dietary preferences and allergies.Please indicate any accessibility requirements.Where are you travelling from?(Required)GTAOutside the GTA but less than 150kmMore than 150km awayDo you require hotel accommodation?(Required) Yes NoPlease note that HEQCO will reserve and pay the hotel directly for one night unless otherwise agreed upon with Amy Kaufman or Laura Gallant.Check-in Date DD slash MM slash YYYY Check-out Date DD slash MM slash YYYY Comments on hotel accommodationThis field is hidden when viewing the formToday MM slash DD slash YYYY Student Ticket Price: Early Bird Price Price: General Ticket Price: Late Registration Price: Onsite Registration Price: Speaker Ticket Price: Speaker Ticket Price: Total Discount Code This field is hidden when viewing the formTotal TextBilling Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Must match credit card addressCredit CardAmerican ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name Speaker Consent(Required) I agree that photographs and audio/video recordings in which I appear during the conference may be used by HEQCO in HEQCO-related materials (including, but not limited to, print, multimedia, and Web products). I agree that my name, organizational affiliation, position/title and professional email address may be printed in the conference program and other conference-related materials (including, but not limited to, print, multimedia, and Web products). Notice of filming and photography for all registrants By attending this conference, you acknowledge that the event is being held in a public venue where photos and videos may be taken. HEQCO may publish photographs and audio/visual recordings taken during the conference in various formats (including, but not limited to, print, multimedia or online). Attendee Consent I consent to sharing my name, title and contact information with participants. We plan to share a list of conference participants with all registrants after the conference to help facilitate connections. Can we include your name, title and contact information on this list?PhoneThis field is for validation purposes and should be left unchanged.
Higher Education Quality Council of OntarioHigher Education Quality Council of Ontario