All cheques or money orders payable to the “STORM Coalition” are to be sent by mail to:
Box 533 Bolton, ON L7E 5T4
Attention: Moraine for Life Symposium

Title / Position
Salutation*
First Name*
Last Name*
Address (Line 1)*
Address (Line 2)
City*
Province/State*
Postal Code/ZIP*
Work/Day Phone*
Work/Day Fax
E-mail*
Do you have dietary restrictions / special needs?
(Please provide details)

Check here if you are a fulltime student and provide school name and valid STUDENT #
(Students must forward a photocopy of their student identification card (showing photo, name & institution) to qualify for student rates)		 Institution:

Student #:
Please check here if you are a volunteer or staff for a non-profit with no operating budget (note that a signed letter from an organization in which you volunteer will be required). Organization:

Please check here if your organization is GST-EXEMPT and include your GST-exemption number. GST Exempt Number:

Please check here if you plan to attend the Banquet Dinner.
Please check here if you plan on taking the morning shuttle on Thursday, April 30th from your hotel in Peterborough to the Ranch Resort. Note: Please fill out the shuttle request form.

Please click the one that applies to your registration:

SUBSIDIZED registration rates now available! Because of the current economic downturn and successful fundraising for the Symposium, we are pleased to offer subsidies to support those who need financial assistance to attend the Symposium.
Federal, provincial and municipal governments, agencies, conservation authorities and private sector companies - Subsidized rate $150 per person. ($50 savings).
Non-governmental agencies - Subsidized rate $50 per person. ($50 savings).
Full-time students and volunteers - Subsidized rate $25 per person. ($25 savings).
Note: this rate will be available for the first 40 delegates registered under this category.
Extra Banquet Dinner Ticket - $50.00 per person