PAN Regional Training March 3rd and 4th, Victoria

General Application Information

PLEASE NOTE: By completing and submitting the information requested in this online registration form, I acknowledge that I have read, understood and accept the travel and accommodation guidelines as they may apply to my attendance. I also agree to complete the post-event evaluations. Information collected via this application form is confidential and will be used solely for the purposes of determining attendance, event evaluation, and for post-event follow up with PAN.

Name(Required)

First Last

Email(Required)

Phone(Required)

City(Required)

Organization or Agency(Required)

Job title at your organization (paid or volunteer)(Required)

I'm registering as:(Required)

Event Participant

Event Presenter (Session or Panel Discussion)

PAN Staff

Do you have any food allergies?(Required)

Do you have mobility or other requirements?(Required)

I agree to complete the evaluation of this training.

Yes

Information for travel and accommodation

Please review travel and accommodation guidelines and answer the following questions.

Read Travel and Accommodation Guidelines

Will you need hotel accommodation on Tuesday, March 3rd night?

Yes

Are you applying for PAN to support your hotel stay?

Yes

Hotel Reservation Information

To streamline the registration process, please complete the information below. PAN will book hotel stays. If you need alternate or additional dates, you must contact Jen Demchuk and/or Emily Taylor-Lariviere at PAN to arrange this. Please Note: A CREDIT CARD or cash deposit will be required upon check-in for incidentals/damage deposit. If you do not have a credit card or are not able to pay a cash deposit, please let us know below in the "special requirements" section.

Please select your ARRIVAL day

Tuesday, March 3

Please select your DEPARTURE day

Tuesday, March 3

Wednesday, March 4

Do you have any special hotel requirements (i.e. wheelchair accessible room, you don't have a credit card for incidentals, etc.)? Please note that the hotel is a non-smoking facility.

I understand that if I require a hotel room in addition to Tuesday, March 3rd night, I agree to contact Jen Demchuk ([email protected]) and/or Emily Taylor-Lariviere ([email protected]) immediately following submission of this application.

Yes

Once this form is complete and you hit "SUBMIT" you will be taken to a confirmation page.