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CHAS Speaker's Dinner Registration Form
Coordinator: Anna Maier
Contact Information
RegisterIndividual(s) Company
Company
First Name
Last Name
Email
Phone
Ticket Selection
Tables of 8 $1200 each
Tickets $150 each
Seating Request
Tickets with table assignment will be emailed to guests prior to the event. A portion of the registration fee is eligible for a tax receipt as per CRA guidelines. To receive a receipt please complete the information in the Donation section.
Donation
The full donation amount and a portion of the registration fee are eligible for a tax receipt. Receipts will be issued after the event.
Amount
Tax ReceiptNot requiredBy EmailBy Mail
Address
City Postal
Payment Information
Total Fees Due$0.00
Method of PaymentCredit Card   Mail in a cheque
Credit Card Number
Expiry DateCVC
Name on card