EmailMe Form - Registration Form

Registration Form

Registration form for the Love Conference 2012.
Registration deadline February 16th, 2012

Please send registration form and payment to:

Institute for the Advancement of Aboriginal Women
Suite 201, 10812 - 178 Street
Edmonton, Alberta T5S-1J3
Phone: 780-479-8195
Toll Free: 1-877-471-2171
Fax: 780-471-2169
Email: loveconference@iaaw.ca
Website: www.iaaw.ca

Registration Fees
$299 —Includes meals and Evening event on Feb. 21st 2012
$50 evening event —Feb.21st 2012
Age
Elder/ Senior 60 +
Youth 15-29
Adult 29-59
Primary Position
Support/Care Worker
Student
Director of Programs
Other
Are You
Status
Non-Status
First Nations
Métis
Inuit
Other
Name
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Business Phone
### - ### - ####
Home Phone
### - ### - ####
Fax
### - ### - ####
Payment Method
PO #
Cheque (Enclosed)

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