First Name of Registrant Legal Last Name of Registrant Prior Last Name of Registrant (if Applicable) Birthdate of Registrant Gender Male Female (Required by Provincial Government) Street Address Apt/Unit Number City Province Postal code Telephone (primary) Email Address Conference Registration Fee: $125 (Register Before March 18th for Early Bird Rate and ONLY PAY $100) Attendance Options Online via Zoom - CRN 21087 (In accordance with the current Provincial Health regulations, Douglas College has been granted a LIMITED number of in-person registration) Leave this field blank