Metropolitan United Church London, Ontario, Canada

Registration Form for ReVITALize: London 2024

• • CONTACT INFORMATION SECTION*
    First Name

    Last Name
  • Your E-mail*
     
  • Phone Number*
    ###-###-#### (No brackets, dashes only)
     
  • Address*
    Street Address*

    Address Line 2

    City*

    Province / State / Region*

    Postal Code / Zip

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    Country*
  • CONFERENCE CHOICE SECTION
    Conference location: Metropolitan United Church, 468 Wellington St., London, ON
    Pre-Conference location: Fairmont Campus, 29 Tweedsmuir Ave., London, ON
    
    OPTION 1:
    Pre-Conference AND Conference 12-14Sep24 (3 Days), 2 lunches included.
    RATE $175.00
    
    OPTION 2:
    Conference ONLY 13-14Sep24 (2 Days), 1 lunch included.
    RATE $125.00
    
    OPTION 3:
    Pre-Conference ONLY 12Sep24 (1 Day), lunch included.
    RATE $50.00
    
    The lunches will have a vegetarian option (until supply runs out).
    
    We are unable to accommodate any other dietary restrictions.
    
    Lunches on Thursday and Saturday are included with your conference fee, however, you may choose to opt-out of the provided lunch(es) by changing the drop-down selection below. You will receive a reduction in your fee, however you will be responsible for providing your own lunch.
    
    Note: If you are attending the 3-day conference, there is no option to decline only one of the lunches.
    
    Select from Drop-down to change option:
    >3-Day Conference 12-14Sep24, 2 Lunches Included, Rate CAD175.003-Day Conference 12-14Sep24, NO LUNCHES, Rate CAD165.002-Day Conference 13-14Sep24, 1 Lunch Included, Rate CAD125.002-Day Conference 13-14Sep24, NO LUNCH, Early Bird Rate CAD120.001-Day Pre-Conference 12Sep24, Lunch Included, Rate CAD50.001-Day Pre-Conference 12Sep24, NO LUNCH, Rate CAD45.00
  • PAYMENT OPTIONS SECTION*
    ***Make note of your total amount due from your selection above, as you will need to enter that amount when your are processing your payment after you submit this form.
    
    Please select how you will be paying (CHECK ONE ONLY):
    E-Transfer

    Credit Card (Mastercard or Visa ONLY)
  • FORM SUBMISSION SECTION*
    NOTE: When you submit this form, a Submission Confirmation will be sent to your email to let you know we received your registration. Once we confirm your payment has been received, we will send you a CONFIRMATION OF REGISTRATION AND PAYMENT email.
    
    When you arrive at the conference, please present an electronic or paper copy of the CONFIRMATION email as your ticket!
    I acknowledge that this registration will not be confirmed until I have sent payment after I submit this form.
  • COMMENT SECTION - Anything else we need to know?
    e.g alternate phone number, questions, feedback
• 
  Submit Form & Proceed to Payment Options