NCRC #36 Registration Form!
First Name / Prenom *
Please enter your first name here.
Last Name / Nom *
Please enter your last name here.
Station / Independent *
Role (Staff/Volunteer/Community Member) / Rôle (personnel/bénévole/membre communautaire) *
Mailing Address / Addresse *
Email Address / Courriel électronique *
Phone Number / Numero de Téléphone *
Example: (123) 123-4567
Please select an option: / Veuillez choisir une option: *
City / Ville *
What dates will you be attending? / Sélectionnez les dates
Method of Payment? | Méthode de paiement? *
Accommodations | Hébergement
Clear selection
Dietary Info / Information diététique
Allergies?
Emergency Contact Information (Name and Phone Number) / En cas d'urgence (Nom et numéro de téléphone) *
Are you interested in presenting at the conference?
Clear selection
If yes/maybe, what topic(s) would you like to present on? What are your areas of skill & expertise?
Please select if any of these broad areas apply
Is there anything else that we should know about?
Clear selection
What best describes me?
How will you be travelling? / Comment allez-vous voyager ?
Clear selection
Do you need assistance in arranging transportation? (including from the train station or airport, or car pooling)
Travelling From
Clear selection
Have you attended the NCRC before?
Have you applied for NCRA Funding?
Clear selection
What areas of the conference most interest you?
Questions, Comments, and/or Concerns?
Are you paying by paypal or credit? *
If so, please visit this link to do so by visiting www.civl.ca/NCRC36 and selecting the appropriate item from the drop down menu above the PayPal logo in the middle of the page.
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