2018 CCCO Registration (Halifax NS)

Registration

1. SELECT APPROPRIATE CHOICE

DELEGATE INFORMATION

CONTACT *This question is required. / Cette question est requise.

First Name of Delegate Attending
Last Name of Delegate Attending
Position / Title
Address
City
Province
Postal Code
Tel. of Delegate Attending

E-mail of Delegate Attending *This question is required. / Cette question est requise. This question requires a valid email address.

(A copy of the registration form will be sent to this e-mail address)

RESTRICTIONS (if applicable)

Special Dietary Needs

Special Accessibility Needs

Key contact for completing the registration form for invoicing purposes (if different from the delegate)

Name

Tel.

E-mail

Please make the cheque payable to “Canadian Capital Cities Organization” and mail to:

Bernadette McIntyre
Treasurer
Canadian Capital Cities Organization
2706 Aster Crescent
Regina SK S4V 1Z6