Note: Fields marked as * are required.

Name	*
Title
Organization	*
Address	*
City	*
Province	*
Postal Code	*
Phone	* (e.g., 4161112222)
Fax
E-mail	*
Special requirements
Meals
Accessibility
Other
Registration fee
Regular registration	$120 (includes a copy of the Let’s Be Healthy Together toolkit)
Method of payment *
Cheque Money Order Credit Card (Pay on-line over a secure connection) Group Credit Card