REGISTRATION FORM

Date: Saturday, April 29, 2017 - 10:00am - 4:45pm
Location: Okanagan Regional Library, Kelowna
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Questions? Please contact Debbie Van Kuyk by email education@chf.bc.ca or by phone 1-866-879-5111 ext. 135

* Required information

* 1. First name:

* 2. Last name:

* 3. Phone number:

* 4. Email address (we will confirm your registration by email)

* 5. Special requirements - Mobility, audio, visual needs? Please indicate below.

* 6. Lunch will be provided, please indicate if you require a vegetarian option.

* 7. Co-op name / organization:

* 8. Authorization: Has your co-op or organization agreed to pay your registration fee?

* 9. If your co-op or organization has agreed to pay, please enter the name of the authorizing person below (i.e. Director at your co-op). If you are paying for yourself, enter "self" in this box.

* 10. If you answered "self" above (your co-op or organization has NOT agreed to pay for your registration), please enter your mailing address below. We will invoice you directly and will require payment before the event.

* 11. Please select your registration option

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