Northern Ontario First Nations
Communications Conference

Sioux Lookout - The Den, Pelican Falls First Nations High School
Timmins - McIntyre Centre - 220 Boulevard Algonquin East
Thunder Bay (NEW LOCATION) Banquet Hall (basement)Matawa First Nations. 233 S. Court St. Thunder Bay, ON P7B 2X9

“Getting Connected: Strengthening the Connections Between Northern Ontario First Nations and the World”

You may register for the conference by submitting this online registration form.

Registration is FREE for the Communications Conference

GENERAL INFORMATION

Name: *

Title:

Organization/Community: *

Mailing Address: *

City: *

Prov: * select...ABBCMBNBNLNTNSNUONPEQCSKYT

Postal Code: *

Telephone: *

Fax:

E-mail:

Web Site Address:

In case of emergency, please contact

Name: *

Telephone: *

Special Diet or Allergies?:

Please specify if you require a special diet or if you have allergies.

First Nations Community Representative?: select...NANTreaty 3

If you are a First Nations Community Representative, select the area your community is in.

Choose a Location: * select...TimminsSioux LookoutThunder Bay

WAWATAY NATIVE COMMUNICATIONS SOCIETY ANNUAL GENERAL MEETING

Friday, December 11, 2009

Will you be attending Wawatay's AGM?: *

Yes

No

WAWATAY NATIVE COMMUNICATIONS SOCIETY MEMBERSHIP

Wawatay Membership Fee $500.00: *

Yes

No

My community wishes to pay the annual Wawatay Membership Fee $500.00 in order to participate in the Wawatay Annual General Membership Meeting on Friday, December 11, 2009.

WAWATAY MEMBERSHIP FEES PAYMENT OPTIONS

Payment Options: select...VisaMaster CardCheque or Money OrderPurchase Order

Cheque or Purchase Order should be faxed and mailed to Wawatay once this form has been completed.

Credit Card Number:

Name on Card:

Expiration Date:

MM/YYYY

Amount Authorization: $

I authorize WAWATAY to charge the above referenced credit card for my membership fees as requested in the total amount above.

Make your cheque payable to Wawatay and mail it to:

Wawatay
Box 1180
Sioux Lookout, ON, P8T 1B7

TERMS:

Cancellation and Refund Policy
Wawatay membership fees are not refundable.

Spaces are limited. Please register by November 20, 2009

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Enter the characters shown in the image.