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National Conference Registration

Date:

May 1-4, 2019

Location:

Montréal, QC

Offering an opportunity to network with colleagues and increase your knowledge and skills in fostering healthy active living for children and youth in their school, family, and community environments.

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Conference Extras / Add-Ons

Extras
Any additional tickets for guests for the Awards Banquet must be purchased as an added cost. Please indicate the number of additional tickets required in the provided drop box for each event.

Become a PHE Canada Professional Member

A one-year membership (a 25% discount off the regular membership rate). Membership will come into effect after the Conference.

I would like to become a Professional Member of PHE Canada ($15).

I would like to become a Professional Member of PHE Canada and subscribe to the PHE Journal ($65)

Delegate Information

*Required

*First Name

*Last Name

*Address

*City

*Province/State

*Country

*Postal/Zip Code

*Phone Number (with area code)

*Email

*Organization / School Board / School

*Which role best reflects your work.

What is your role?

*Age

Communications

*Email

I would like to receive other news and announcements from PHE Canada.

I would like to receive other news and announcements from APEQ

I would like to receive other news and announcements from FEEPEQ

*Language Preference

English

French

Conference Considerations

*Shirt Sizing
Only those registering prior to February 28, 2019 will receive a Conference T-shirt.

*Conference Sessions (select all that apply):

I will attend conference sessions in English

I will attend conference sessions in French

Dietary Requests

Vegetarian

Vegan

Other (please specify)

Dietary Requests - Additional Details

Medical Considerations
If you have any medical conditions or allergies that we should be aware of, please describe them below.

Accessibility Requirements
Please indicate any accessibility requirements that PHE Canada, APEQ, FEEPEQ, and facility staff should be aware of. If you require a support person to accommodate a disability, please contact PHE Canada at 613-523-1348 or [email protected] x. 229 for more information on registering.

*Emergency Contact Name

*Emergency Contact Telephone Number

*Will this Emergency Contact be on site at the Conference?

Yes

*Secondary Emergency Contact
Please provide an emergency contact not on site at the Conference.

Emergency Contact - Off-site Telephone Number (include area code)

Delegate Consent

*Delegate Consent

By completing and submitting this form: 1) I give consent to PHE Canada, APEQ, and FEEPEQ to collect my personal information in order to process my conference registration 2) I agree to allow conference staff to take photos or video of me as part of the conference, and that if I have any concerns I will speak to a representative at delegate check-in.

Payment Options

Summary

Discount Code:

Discount:

Total (CAD):

Deposit:

Credit Card MasterCard

You will be prompted to enter card details after submitting this registration.

Cheque

We will email you an invoice with payment instructions.

Questions?
If you have any questions, please contact Jordan Burwash at 613-523-1348 x2339 or [email protected].

Cancellations and Refunds Policy
If you need to cancel your registration, refunds less a $50 cancellation fee are available until February 28, 2019. No refunds will be issued after February 28, 2019
.

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