IDTS

Order Information

Item	Amount
Educational Workshop	$50.00
Sub Total:	$50.00
GST:	$2.50
Total:	$52.50

Registration

First Name *

Last Name *

Email *

Confirm Email *

Show Display Name On Site

Display Name

Password

Password *

Confirm Password *

Specify Your Mailing Address

Street Address *

City *

Country *

Province/State *

Postal/Zip Code *

Phone *

Alt. Phone

Course Registration Info

Registration Type *

I want to participate online

I want to participate in person

Payment Information

Credit Card #

Security Code

Exp Date (MM/YY)

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