REGISTRATION FORM

Date: Saturday, April 29, 2017 - 10:00am - 4:45pm
Location: Okanagan Regional Library, Kelowna
Privacy / security: This registration form is powered by SurveyMonkey. Click here for their privacy policy. Your information will only be used by CHF BC to communicate with you about this event. View CHF BC's privacy statement.
Questions? Please contact Debbie Van Kuyk by email education@chf.bc.ca or by phone 1-866-879-5111 ext. 135

* Required information

Question Title

* 1. First name:

Question Title

* 2. Last name:

Question Title

* 3. Phone number:

Question Title

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

Question Title

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

Question Title

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

Question Title

* 7. Co-op name / organization:

Question Title

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

Question Title

* 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.

Question Title

* 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.

Question Title

* 11. Please select your registration option

T