Building Vibrant Communities: Contributing to Social Transformation                                           June 3, 2023  
Please fill out this brief form to indicate your interest in joining us for the "2023 Building Vibrant Communities: Contributing to Social Transformation" Conference on Saturday, June 3, 2023 from 9:30am until 3:30pm. This gathering is hosted by the Office of Public Affairs for the Bahá’ís of London, ON. 
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First Name *
Last Name *
Phone Number
Are you filling this out for yourself only or for others also (including family members, friends, children, junior youth, etc)?
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If you are filling this out for other ADULTS or YOUTH AGED 15+ in addition to yourself, please include their names below (first name, last name):
If you are bringing JUNIOR YOUTH (aged 11-14) in addition to yourself, please include their names below and their age(s):
If you are bringing CHILDREN (aged 5-10) in addition to yourself, please include their names below and their age(s):
If you are bringing YOUNG CHILDREN (aged 0-4) in addition to yourself, please include their names below and their age(s):
If you are bringing children or junior youth in addition to yourself, please include the name and cell phone number of an emergency contact who will be at the conference (in most cases, this will be you):
Please state any dietary restrictions/allergies below. If you are filling this out for other people as well (including children/JY), please specify who the restrictions/allergies are for. If this does not apply to you, please indicate N/A or leave blank.
In addition to plenary sessions, there will be small group sessions.  If there is anyone with whom you are attending the conference AND would like to be placed in the same group (if possible), please state their name(s) below. This can include people you are filling this form out for, or other people as well. If this does not apply to you, please indicate N/A or leave blank.
Do you happen to still have your book from last year's conference that you can bring? (If not, that is okay. We will have more copies of the book, and in multiple languages). 
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During the conference, photographers will be taking pictures and video recordings. Do you give permission for your image to be used on the London Bahá’í social media platforms. 
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