Climate Change for Social Impact Leaders Registration Form - October, 2025

Name*

First Last

Job Title

Company

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Email*

Choose your Registration Fee from the List*

Very Early Registration (register by August 5, 2025): $475 plus 13% HST
Very Early Registration (register by August 5, 2025). Team Rate (2 or more) Discount: $425 plus HST
Very Early Registration (register by August 5, 2025). Charities, Not-for-Profit & Small Business: $325 plus 13% HST
Early Registration (register by September 5, 2025): $575 plus 13% HST
Early Registration (register by September 5, 2025). Team Rate (2 or more) Discount: $525 plus 13% HST
Early Registration (register by September 5, 2025). Charities, Not-for-Profit & Small Business: $375 plus 13% HST
Regular Registration: $675 plus HST
Regular Registration: Team Rate (2 or more) Discount: $625 plus HST
Charities, Not-for-Profit & Small Business: $295 plus plus 13% HST

Number of Registrants*

Please enter a number from 1 to 10.

Put the number of registrants here (include yourself in this number). If there is just 1 registrant, the number will be 1.