New Brunswick Environmental Network

Registration Deadline: Wednesday march 8, 2012

Registration fee: $15

Registration information:

-Meals included.

-Limited travel & registration subsidies are available to those who register before the deadline.

-Registration fee is non-refundable. If you are unable to attend, please provide at least 48-hours' notice of cancellation. In order to cover workshop expenses, all registrants who do not attend and who do not provide sufficient notice of cancellation will be invoiced. We appreciate your understanding of our attempts to keep workshop costs as low as possible.

First Name (*)

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Last Name (*)

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Group Affiliation

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Mailing Address

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City

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Province

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Postal Code

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Email Address (*)

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Home Phone Number (*)

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Cell Phone Number

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Emergency Contact Name (*)

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Emergency contact relationship to you (*)

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Primary phone number for emergency contact (*)

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Back up number for emergency contact

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How did you find out about this event?

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Languages Spoken

English

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French

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Mi’Kmaq

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Wolustukwiyik (Maliseet)

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I require translation for

English discussion

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French discussion

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Meals

I will be present for Saturday supper

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I will be present for Sunday breakfast

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I will be present for Sunday lunch

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I am vegetarian

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I am vegan

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Other special needs/allergies

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accommodation (*)

I have all my own sleeping gear and will be staying with the group at the curling centre
I have some questions about where we are staying please contact me directly
I will be sleeping at home

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There is lots of space to stay in the curling centres hall but everyone needs to bring their own sleeping bag, sleeping mat and pillow.

Transportation

I am able to offer transportation to others

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Please send me information on potential rides

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-Limited transportation subsidies are available to those who register before the deadline. To reduce emissions, carpoolers are eligible for a higher per-km reimbursement rate.

I require a travel subsidy

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Payment

My cheque is in the mail *

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I will pay at the door

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-Limited registration subsidies are available to those who register before the deadline.

I require a registration subsidy

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-If you are unable to attend, please provide 48-hours' notice of cancellation. Registration fees will be waived if sufficient notice of cancellation is provided.

-*Please make cheques payable to the New Brunswick Environmental Network and send them to: New Brunswick Environmental Network, 167 Creek Road, Waterford, NB E4E 4L7.

Verification Code

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Problems or questions? Contact the NBEN at 506-855-4144 or nben@nben.ca.