Climate Change for Social Impact Leaders Registration Form

Unlocking Resilience: Climate Change for Social Impact Leaders Registration Form

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 Dropdown List*
- Very Early Registration (register by June 30, 2024): $375 plus 13% HST
- Very Early Registration (register by June 30, 2024). Team Rate (2 or more) Discount: $325 plus HST
- Early Registration (register by August 15, 2024): $ 475 plus 13% HST
- Early Registration (register by August 15, 2024). Team Rate (2 or more) Discount: $ 425 plus 13% HST
- Regular Registration: $ 575 plus HST
- Regular Registration: Team Rate (2 or more) Discount: $ 525 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.
Name of additional Team Member Attending*
First Last
Name of additional Team Member Attending*
First Last
Name of additional Team Member Attending*
First Last
Name of additional Team Member Attending*
First Last
Name of additional Team Member Attending*
First Last
Name of additional Team Member Attending*
First Last
Name of additional Team Member Attending*
First Last
Name of additional Team Member Attending*
First Last
Name of additional Team Member Attending*
First Last
I confirm that I work for a Charity, Non Profit, Social Enterprise or Small Business with 10 employees or fewer.*
- Yes, I confirm
- Oops, I chose this by accident! (please go back and choose another payment rate)
Total includes HST
$ 0.00 CAD