Please fill out the following and submit your registration. 

There are a limited number of seats so early registration is encouraged.

 

 

 

First Name:
Last Name:
Contact No.:
Email:
Province/State/Country:
Male or Female:
Are you or any member of your family a Revert Muslim?
Spouse Name:
Number of children between 2-12 attending:
Number of teenagers attending:
Will you need daycare?:
Workshops/lectures most interested in attending: (please write them out)
Can you voulunteer at this event?: (yes or no) If so please describe (briefly) where and how
Would you like to donate or sponsor to this event? (yes or no) if so please describe (briefly) how.
Payment method: (cash/cheque)