2012 Kelowna Conference Registration Form

Photo of Kelowna, British Columbia and Lake Okanogan (http://www.flickr.com/photos/badcomputer/)

You may complete this registration form (and your payment) online, or download a copy of the registration form and email it to us or send it in by mail.

Name * Field is required.

Address 1 * Field is required.

Address 2

City * Field is required.

Province * Field is required.

Postal Code * Field is required.

Cell Phone

Telephone * Field is required.

Email Address

We're asking about your workshop preferences simply to get a rough idea of numbers. You may change your mind later.

Workshop Preference

Employability, an online national course--an informative Presentation from Anu Pala from Niel Squire Society

Assertive training--role play scenarios to improve on self advocacy skills

Saturday lunch option

Meat lasagna, salad, dessert, tea/coffee

Vegetable lasagna, salad, dessert, tea/coffee

I do not wish to order a Saturday lunch

If you have any dietary restrictions, please specify

How will you be travelling to Kelowna? * Field is required.

Estimated time of arrival

Departure Time

How will you pay your registration fee?

I will mail a cheque to AEBC after submitting this form

I will pay online (through PayPal) after submitting this form

I will pay by VISA or MasterCard, and call AEBC (1-800-561-4774) to provide my card number and expiry date

Other (specify below)

Other comments

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How many colours in the list blue, ant and brown? * Field is required.

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