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Fields
Your Information
Your Name
*
First Name
*
Last Name
*
Address
*
Address Line 1
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
*
Email
*
Event ID
Attendees
How many of your immediate family will be attending? (subsdized rate)
Children
*
$ 18.00
Quantity:
--
1
2
3
4
5
6
7
8
9
10
Parents
*
$ 35.00
Quantity:
--
1
2
Will additional family members be attending? (Grandparents etc.)
Yes
No
Children
*
$ 25.00
Quantity:
--
0
1
2
3
4
5
6
7
8
9
10
Adults
*
$ 45.00
Quantity:
--
0
1
2
3
4
5
6
Will Nut-free meals be required?
Yes
No
Children
*
FREE
Quantity:
--
0
1
2
3
4
5
6
7
8
9
10
Adults
*
FREE
Quantity:
--
0
1
2
3
4
5
6
Number of Attendees
Attendee #1
*
First Name
*
Last Name
*
Attendee #2
*
First Name
*
Last Name
*
Attendee #3
*
First Name
*
Last Name
*
Attendee #4
*
First Name
*
Last Name
*
Attendee #5
*
First Name
*
Last Name
*
Attendee #6
*
First Name
*
Last Name
*
Attendee #7
*
First Name
*
Last Name
*
Attendee #8
*
First Name
*
Last Name
*
Attendee #9
*
First Name
*
Last Name
*
Attendee #10
*
First Name
*
Last Name
*
Would you like to be a sponsor and help cover the costs of the evening? (tax deductible)
$36
$54
$100
$180
$360
Other:
Other Value
Total
$
Payment
Credit Card
*
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