Canadian Foundation Event Registration

For attendees from Canada and other countries

This is an add-on event registration separate from the full registration. Toronto locals - please use the form below to purchase tickets.

This registration form will process payment to the Canadian Foundation in CAD. If you wish to process your payment through the US Foundation in USD instead, please use this form.

Proceeds from the event will go to Tel Aviv University School of Dental Medicine Oral Pathology Laboratory Project and the Radiology Center at the new Oral Health Center for People with Disabilities at the Hebrew University Hadassah School of Dental Medicine.

$70 of the Canadian Foundation event cost is tax-deductible.

Prefix

First Name *

Last Name *

Preferred First Name/Nickname

Chapter *

Write "None" if not affiliated with a chapter.

Address *

Address 2

City *

Postal Code/Zip Code *

Country *

State *

Phone

Email *

Will you require Kosher meals?

Yes

No

How many additional guests (not including you)?

Share the names of your guests

Payment Information

Amount

CAD

Payment Method *

Canadian Foundation Paypal Send Check via Postal Mail

Credit Card Number*

Expiration Date*

/

Card (CVV) Code*

Card Holder Name*

Please donate to offset PayPal fees

Enter your donation amount above. Suggested donation is 3%, or $6 per ticket.

Additional Donation to the Foundation

$180

$360

$720

Other

Enter your custom donation amount:

Numbers only, do not enter $ or punctuation

By registering for this event, I accept the Alpha Omega Dental Society Code of Conduct