CCNA XXXI Quebec Pre-Registration Email Money Transfer

Please use this form to register for CCNA being held in Saint-Hyacinthe, Quebec. This form uses Email Money Transfer for payment. If you have any questions about how Email Money Transfers work check with Interac or send us an email

If you prefer to pay for your registration by credit card please click here

Upon the conclusion of this registration you will be asked to send your Email Money Transfer within 24 hours to orders@canadianconvention.com. You will receive confirmation of payment from CCNA and your financial institution. If that payment is not received within 24 hours your registration submission shall be deleted from our system. Your financial institution may charge a small fee to complete this Email Money Transfer.

1First Registrant > 2Second Registrant > 3Review > 4Payment
Email Confirmation Sent
Have you previously made a purchase from CCNA XXXI and now making additional purchases? *

Have you previously made a purchase from CCNA XXXI and now making additional purchases? No, I have not registered Yes, I have registered previously
Registrant

Complete this section for the first registrant (there is a section for a second registrant on the next page if you select the option to add another registrant)
Name Name * First Last
Though this is an anonymous program, your full name would be very helpful in processing your registration
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
Email *
Would like to have your email address added to our mailing list to receive convention updates? *

Would like to have your email address added to our mailing list to receive convention updates? Yes No
Clean Date Clean Date / MM / DD YYYY
Are you interested in serving?

Are you interested in serving? Speaker (minimum 3 years clean) Chair Person (minimum 2 year clean) Sub Committee (clean time requirement will be determined)
Select your package or items from below.

Early Bird Full Package includes everything listed below.

You may also purchase multiple Early Bird Basic Registrations to distribute yourself at a later date.

Early Bird registrations are only available for purchase until Feb 28, 2023

*

Select your package or items from below.

Early Bird Full Package includes everything listed below.

You may also purchase multiple Early Bird Basic Registrations to distribute yourself at a later date.

Early Bird registrations are only available for purchase until Feb 28, 2023

Pre-Registration Full Package-$165.00 Pre-Registration - $40.00 2 Pre-Registrations - $80.00 3 Pre-Registrations - $120.00 4 Pre-Registration - $160.00 5 Pre-Registration - $200.00 Comedy Show-$20.00 Saturday Banquet - $60.00 Saturday Dance - $15.00 Sunday Breakfast - $30.00

Early Bird Full Package includes everything listed below. Early Bird registrations are only available for purchase until Feb 28, 2023
In an effort to provide an alternative you are welcome to request a vegetarian or a vegan meal. Do you wish to request a special meal at the banquet?

In an effort to provide an alternative you are welcome to request a vegetarian or a vegan meal. Do you wish to request a special meal at the banquet?

Regular Meal Vegan Option Vegetarian Option
New Comer Contribution ($40.00 will purchase a basic package for a new comer but donations of any and all values are appreciated) $ Dollars . Cents
Monies collected through this process are used to assist those who cannot afford a registration package. Early Bird Basic Registration is $40.00. Please contribute any dollar amount you can.
Add a second registrant? *

Add a second registrant? Yes No
C$0

Total

CCNA XXXI Quebec Pre-Registration Email Money Transfer

CCNA XXXI Quebec Pre-Registration Email Money Transfer

Registrant

C$0

Total

C$`0`