Indigenous Wellbeing Conference Participant Registration

Online Registration

"*" indicates required fields

Registration Type

Individual

Group

Vendor

Vendor Information

Contact Name*

First Last

Company Name*

Phone*

Email*

Address*

Street Address Address Line 2 City Province Postal Code

ARTS & CRAFTS – 1 Table

Please enter a number from 1 to 5.

$180/Day x 2.5 Days = $450

ARTS & CRAFTS – 1 TABLE w/ 1 Clothing Rack

Please enter a number from 1 to 5.

$180/Day x 2.5 Days = $450

INFORMATION – 1 TABLE

Please enter a number from 1 to 5.

$180/Day x 2.5 Days = $450

Total

ANSN Tax Exempt #106697972RP0001

Participant Information

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City Province Postal Code

Earlybird Total (on or before January 2, 2025)

ANSN Tax Exempt #106697972RP0001

Regular Total (after January 2, 2025)

ANSN Tax Exempt #106697972RP0001

Sponsor Information

Organization Name*

Contact Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City Province Postal Code

Number of Participants*

Please enter a number less than or equal to 10.

Group Participant Names

1.*

First Last

2.*

First Last

3.*

First Last

4.*

First Last

5.*

First Last

6.*

First Last

7.*

First Last

8.*

First Last

9.*

First Last

10.*

First Last

Earlybird Total (on or before January 2, 2025)

ANSN Tax Exempt #106697972RP0001

Regular Total (after January 2, 2025)

ANSN Tax Exempt #106697972RP0001

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Payment Method

Payment Method*

Cheque

Money Order

Electronic Funds Transfer

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Consent - Attendees

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Consent - Vendors

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Phone: (780) 967-2225

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