You are registering for the Entrepreneur to CEO Workshop. Please complete the information below to register online.

This Small Business Retreat is an Exclusive Event for CETAC-WEST clients and invited guests. If you are interested in more information on how to become a CETAC-WEST client, please send an email to cetac@cetacwest.com.

Workshop alumni who previouisly submitted a bio and photo to CETAC: if your contact and bio information has not changed, please mark each box with a "x".

1. Please provide the following contact information:

First Name:	*** Required Field
Last Name:	*** Required Field
Job Title:	*** Required Field
Company Name:	*** Required Field
Street Address:	*** Required Field
Address (cont):
City:	*** Required Field
State/Province:	*** Required Field
Zip/Postal Code:	*** Required Field
Country:	*** Required Field
Phone:	*** Required Field
Fax:
Email:	*** Required FieldMust enter a valid email address (name@host.com)

2. Choose your room:

Single Room - CAD 260
Double Room - CAD 195 (per person)

Note: meals are included with hotel accommodation. If you have any special dietary requirements, please note so in Notes and Special Requests area below.

3. Travel dates for Hotel Reservations and Seminar Registration:
*Registrants are encouraged to arrive mid afternoon

Arrival Date:	(e.g. 2010-02-08) *** Required Field Format must be YYYY-MM-DD
Departure Date:	(e.g. 2010-02-12)*** Required Field Format must be YYYY-MM-DD

4. Please provide the following payment information:

VISA (we will contact you to obtain your VISA information)
MasterCard (we will contact you to obtain your MasterCard information)
American Express (we will contact you to obtain your American Express information)
I do not wish to use a credit card - please contact me with alternatives

5. Please provide the following biographical information:

Please share a small paragraph describing your company, business or project: *** Required Field

What Product or Service is Offered?	*** Required Field
What is the business area of focus of your company?	*** Required Field
What is the market niche?	*** Required Field
What is the size of your company (personnel)?	*** Required Field

Please describe yourself - what you do and your background *** Required Field

6. Please provide a photo of yourself Please provide a photograph in .jpg format. It should be no larger than 1000kb in size and have dimensions no smaller than 640 x 480 pixels.

7. Notes and Special Requests:

 

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