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*
- Early Bird! (register by April 30, 2024): $575 plus 13% HST
- Early Bird! (register by April 30, 2024). Team Rate (2 or more) Discount: $525 plus HST
- Regular Registration: $ 675 plus HST
- Regular Registration: Team Rate (2 or more) Discount: $ 625 plus HST
- Charities & Not-for-Profit Organizations: $295
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 or Non Profit or Social Enterprise with 10 employees or fewer.*
- Yes, I confirm
- Opps, I chose this by accident! (please go back and choose another payment rate)
Total includes HST
$ 0.00 CAD