Community Event Registration 2020

Registrants Name*
First Last
Registrants Email*
Registrants Phone Number*
Registrants Address*
Street Address City Province Postal Code
Business Name*
Event Address*
Street Address
Event Date*
Date Format: MM slash DD slash YYYY
Start Time*

: HH

MM
End Time*

: HH

MM
Notes*
Accompanying Photo Upload
Business Logo Upload*
Product Name*
Price: $ 25.00 CAD
Please note that your fee may be reviewed and that additional charged may be incurred. We will contact you before any further charges.
Total
$ 0.00 CAD
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name