First Name *

Last Name *

Organization and Role

Mailing Address

City

Province Choose a Province BC - British Columbia AB - Alberta MB - Manitoba NB - New Brunswick NF - Newfoundland NS - Nova Scotia NT - Northwest Territories NU - Nunavut ON - Ontario PE - Prince Edward Island QC - Quebec SK - Saskatchewan YK - Yukon

Postal Code

Phone *

E-mail

Number of children attending (Please indicate age and gender)

Meals: please check which meals you will be attending

Dietary restrictions:

I would like to bring the following food (type and quantity):

I would like to share my room with:

How do you intend to get to the gathering (check one):

• Car
• Bus
• Airplane
  Note airport

If yes, how many passengers can you bring? # passengers 1 2 3 4 5 6 7 8 9 10

I need a ride to the Gathering from .

I need a ride from the Gathering to .

I would like to volunteer with:

• Food Preparation / Serving
• Child Care
• Note Taking
• Registration

I need a subsidy for my attendance because:

I can pay $

I need a subsidy for children ages .

Registration fee: $295

Extra Accommodation fees (if applicable): $

Total: $ to be sent by postal mail (received by September 1st)

NOW, the most IMPORTANT part: Getting to Know You!

We will be putting together a contact list with the name, contact information and a brief bio of everyone who attends the Gathering. You will receive a copy of this list in your registration package. Please take a minute to provide a SHORT biography about who you are and what you do.

For example:
I am an avid gardener and eater, mother of two and board member of my local food policy council. I am passionate about food, social justice and sustainable agriculture. I am currently working for the local youth center where I am trying to get a compost going and getting youth to use a plot at the community garden.

Enter your bio:*

• Yes
• No