REGISTRATION FORM -  Scott Taylor CAJ Event - National Press Club - Ottawa 
                      November 10, 2004

 Print and fax completed registration form to: 613-725-0570
  
 Please provide ALL information requested below:
  
 Name:__________________________________________________

 Address:________________________________________________

 City/Prov/Postal Code:_______________________ / ____ / _____-_____

 Home tel: (_____) _____ - _____________  Fax: (_____) _____ - _____________

 E-mail:___________________________ @ ____________________
 
 Employer/School:_________________________________________
 
 CAJ Member: ___ Yes ___ No

 Registation Rates:

 CAJ Members: $10.00 in advance - (Save $2 - $12.00 at the door) 
 (CAJ student members $6.00 - flat rate)

 Non-Members $15.00 in advance - (Save $5 - $20.00 at the door) 
 (non-member students $7.50 - flat rate)

 Registration fee $ ________________

 Grand Total $ ________________

 Method of payment (Please ensure all information is complete)

1. ____ Enclosed is my cheque (or money order) payable to the Canadian Association 
 of Journalists - National Capital Region.  Mail to CAJ Event, 242 Westhaven 
 Crescent, Ottawa, Ontario, K1Z 7G3  
 (After November 1, credit card only for advance payment orders.)
  
2. Please charge my Visa ___ or my Master Card ___

 Name exactly as it appears on Card:________________________________________

 Card no:__________ - ___________ - ___________ - ___________

 Expiry date: ___ / 200__
 
 Signature: _____________________________________________
 
 3. ____ I will pay at the door. (NOTE: Those who have pre-paid registration in 
 advance will, if necessary be given seating preference over those who pay at the 
 door. Pay at door advance registrants who arrive after 6:30 p.m. will be charged 
 the full pay-at-door rate.)

 Print and fax completed registration form to: 613-725-0570

 For further information, contact:  (613) 725-6279 #3 or e-mail: caj_ottawa@yahoo.ca