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Street 2

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Personal Information

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Choose a Program *

Program

Overview:

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Course

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Registration Fee:

$ CAD

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Please specify your dietary restrictions if there is any.

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Eligibility

I have read the eligibility criteria above and would like to register to this course / program.

Personal Information

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Address:

Program / Course Chosen

Program:

Course:

Base Price

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Subtotal

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Discount

- CAD

Discount Applied

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Tax

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Subtotal

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TOTAL

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Personal Information

Name:

Role:

Email:

Phone:

Organization:

Address:

Program / Course Chosen

Program:

Course:

Base Price

CAD

Number of seats

Qty

Subtotal

CAD

Discount

- CAD

Discount Applied

CAD

Tax

CAD

Subtotal

CAD

TOTAL

CAD

Pay by Card

Health Innovation Action uses 256 bit AES encryption. All data is secure using TLS and processed via a PCI certified payment gateway. No payment card data is retained by Health Innovation Action.

Upon completion of your payment, you will receive a receipt by email.

Personal Information

Name:

Role:

Email:

Phone:

Organization:

Address:

Program / Course Chosen

Program:

Course:

Base Price

CAD

Number of seats

Qty

Subtotal

CAD

Discount

- CAD

Discount Applied

CAD

Tax

CAD

Subtotal

CAD

TOTAL

CAD

Pay by Electronic Funds Transfer or Cheque

Payment Directions

1. Cheque payment

Make cheques payable to:

Health Innovation Group (HIG) 112 Parkview Place SE, Calgary, AB, T2J 4W5

There is fee of $5.00 CAD included when processing cheque payment.

2. Electronics Funds Transfer

Institution Number: 003

Account Number: 1341015

Transit Number: 00009

Routing Number (ABA Number): 021000021

SWIFT Number: ROYCCAT2

3. Interac Transfer

For organizations paying by E-Transfer, the payment should be sent to:

Improve@healthinnovationgroup.ca

I have read the directions above and have printed a copy of this page

Register

Please provide your name and contact information.

Please provide information about your organization.

Address

Personal Information

Program

Course

Eligibility

Personal Information

Program / Course Chosen

Enter coupon code:

Select your preferred payment method

Personal Information

Program / Course Chosen

Pay by Card

Personal Information

Program / Course Chosen

Pay by Electronic Funds Transfer or Cheque

Payment Directions

1. Cheque payment

2. Electronics Funds Transfer

3. Interac Transfer

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