2025 AMICCUS-C Regional Conference Registration

Conference Registration
Name*

First NameLast Name
Preferred Pronouns
Member Association Name*
Non-Member Association Name
Job Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact Name*
Emergency Contact Number*
Please enter a valid phone number.
Do you require any specific accessibility concern or accommodations that the conference hosts should be aware of?
Will you be attending the opening reception (Oktoberfest)?*

YesNo
Will you be attending the closing reception?*

YesNo
Do you have any dietary restrictions?

Delegate Fee*

Member Plus HST

$350.00CAD

Non-MemberPlus HST

$450.00CAD

Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD

Land Acknowledgement

AMICCUS-C acknowledges the homelands of the Indigenous Peoples of Turtle Island, this place we now call Canada, and honours the many territorial keepers of the Lands on which we work.
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