Registration Form

* Required fields

Attendee Information

First Name: *

Last Name: *

Title: *

Institution: *

Address: *

City: *

Province: *

Postal Code: *

Phone: *

Email: *

(K2K 2K2)

(123-456-7890)

(email@host.com)

Do you agree to have your name and contact information included on the delegate list?

Registration Information

Registration Options:

Additional Options

Please check the option and/or enter the amount (number) for the desired option(s) in the field provided.

Pre-Conference Workshop - $85

Do you want a traditional White Stetson reserved for you (no charge)?

Guest Tickets for Closing Function (June 14, 2011) - $60

Special Dietary Needs

Allergies

No seafood

Vegan

Vegetarian

Other

If applicable, specify in comment field below:

The personal information collected on this form will be used for processing your registration request. It is collected under the authority of section 33 (c) of the Alberta Freedom of Information and Protection of Privacy Act. If you have any question about the collection and use of this information, contact CASFAA.

Athabasca University - Last Updated January 31, 2011