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B a s i c s o f G e o l o g y, M i n i n g a n d Mineral Processing for the Investment Community September 19 & 20, 2010 Registration First Name: Last Name: Company: Address 1: Address 2: City: State/Province: Postal Code Country Email Address Contact Phone Number What area(s) is (are) of interest to you?

Visa MasterCard Method of Payment: Cheque (Please make cheques payable to Queen’s University) Bank Transfer

For Credit Card Use: Card Number:

Expiry:

Signed: Date:

**PLEASE FAX TO KATE AT 613-533-6597**


Registration Form