CAGP Vancouver Island Legacy Speed Networking event | CAGP

Event Registration

How many people are you registering? *

(including yourself)

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

Event Fee(s) *

Member - $ 10.00

Non-Member - $ 20.00

Total for this participant

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Event Registration