Role (Staff/Volunteer/Community Member) / Rôle (personnel/bénévole/membre communautaire) *
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Mailing Address / Addresse *
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Email Address / Courriel électronique *
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Phone Number / Numero de Téléphone *
Example: (123) 123-4567
Your answer
Please select an option: / Veuillez choisir une option: *
City / Ville *
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What dates will you be attending? / Sélectionnez les dates
Method of Payment? | Méthode de paiement? *
Accommodations | Hébergement
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Dietary Info / Information diététique
Allergies?
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Emergency Contact Information (Name and Phone Number) / En cas d'urgence (Nom et numéro de téléphone) *
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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?
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Please select if any of these broad areas apply
Is there anything else that we should know about?
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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)
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Travelling From
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Have you attended the NCRC before?
Your answer
Have you applied for NCRA Funding?
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What areas of the conference most interest you?
Questions, Comments, and/or Concerns?
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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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