DISTRICT 86 - 2016 FALL CONFERENCE REGISTRATION FORM
First Name *
Your answer
Last Name *
Your answer
Club Name *
Your answer
Club # *
Your answer
Email *
Your answer
Phone Number *
Your answer
Communication Designation *
Required
Leadership Designation *
Required
Are You a
Conference Package *
(Select One)
Admission to Contests Only
(Option available only if Full Conference package not selected)
Meal Options: Friday Night (Full Conference or Option 1 only) *
(Select One)
Meal Options: Saturday Night (Full Conference or Option 2 only) *
(Select One)
Dietary Restrictions
(Please Specify)
Please Identify Allergies
Your answer
Is this your first Conference? *
(Select One)
Will you be receiving your DTM at this conference? *
(Select One)
Will you be bringing your club banner? *
(Select One)
Will you be bringing club proxies (as Club President or VP Education or as a member of your club)? *
(Select One)
How many club proxies will you be bringing? *
(Select 1 or 2 if you answered Yes above, otherwise select None)
Would you like to volunteer? *
(Select One)
If you answered Yes to the above question, which area would you like to volunteer?
(Select One)
Notes:
A Paypal link will be sent in a separate email in the future once we have it ready.

Cheques Payable to: District 86 Toastmasters

Mail to:
Attn: District 86 Finance Manager
42 Oblate Crescent
Brampton, Ontario, L6Y 0L3

Cancellations no later than Nov. 7, 14 working days before the conference. NSF cheques subject to $35 charge. Administration fee of $35 will be applied to all cancellations.
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