Corporate Registration - diversityconference

Full 3 Days Registration Form

Corporate Member Registration
Name (As it is in your passport)*

First NameLast Name
Additional Attendees*
Corporate Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Email*
[email protected]
Phone Number

Country CodeArea CodePhone Number
Do you require visa to Canada?*

YesNo
Passport # (If visa letter is needed)
Passport Issuing Country
Date of Birth
MM/DD/YYYY
Upload All Passport Copies As One File

Only upload your passport biodata page
Cancelof
Referred by
How did you hear about WODIL*
Disability

I am disabled and will need event access assistance
What are your disability needs
Any food requirements?*

VeganVegetarianGluten FreeNone
WODIL Terms and Conditions*
Billing address

Billing address same as mailing addressBilling address different from mailing address
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

My Products

Full Registration

Full 3 Days Registration Full 3 days in-person registration

$950.00CAD No. of Persons
Item subtotal:$0.00CAD

Enter coupon

Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD

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