2022 Eastern Region Retreat Registration

Are you filling out this form on behalf of someone else?*

No, I am registering myself
Yes

Payment for multiple registrations
You will have the opportunity to make payment for multiple registrations in a single transaction. To do so, please complete the registration form for each participant and select the "My chapter will make payment arrangements" method of payment for each one. Once everyone is registered, you can still pay with a single cheque or e-transfer, or you have the option of paying with credit card/Paypal using the link provided in the confirmation page (after submitting your last registration) and in the email confirmation you will receive.

Admin Name*

First Last

Admin Email*

Admin Phone*

Staff Name*

First Last

Staff Email*

Phone*

Chapter*

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Email

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