Facing the Elephant in the Room: A Conversation About Death with Death Doula Liz Finney

If you have a discount code, enter it here

Event Registration Form

First Name / Prénom *

Last Name / Nom *

Job Title / Titre professionnel *

Organization / Organisme *

Email Address / Adresse de courriel *

Phone Number / Numéro de téléphone *

Street Address / Adresse civique

Street Address 2 /Adresse civique (suite)

City / Ville *

Province *

Postal Code / Code postal

RSVP Comments / Commentaires concernant votre inscription

Additional Comments / Commentaires additionnels

Dietary Restrictions /Régime alimentaire particulier

Are you a member of CAGP? *

Yes/Oui No/Non

Event Fee(s) | Frais d'inscription à l'événement *

CAGP & AFP Members - $ 10.00 + $ 0.00 Tax

Non-members & Guests - $ 15.00 + $ 0.00 Tax

Credit Card Information | Informations sur la carte de crédit

Card Type

Card Number

Security Code

Expiration Date

My billing address is the same as above

Billing Name and Address | Nom et adresse de facturation

Billing First Name

Billing Middle Name

Billing Last Name

Street Address

City

Country

State/Province

Postal Code

Langues